Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association.

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Health burden from food systems is highly unequal across income groups.

Food consumption contributes to the degradation of air quality in regions where food is produced, creating a contrast between the health burden caused by a specific population through its food consumption and that faced by this same population as a consequence of food production activities. Here we explore this inequality within China's food system by linking air-pollution-related health burden from production to consumption, at high levels of spatial and sectorial granularity. We find that low-income groups bear a 70% higher air-pollution-related health burden from food production than from food consumption, while high-income groups benefit from a 29% lower health burden relative to their food consumption. This discrepancy largely stems from a concentration of low-income residents in food production areas, exposed to higher emissions from agriculture. Comprehensive interventions targeting both production and consumption sides can effectively reduce health damages and concurrently mitigate associated inequalities, while singular interventions exhibit limited efficacy.

Ambient traffic related air pollution in relation to ovarian reserve and oocyte quality in young, healthy oocyte donors.

Studies in mice and older, subfertile women have found that air pollution exposure may compromise female reproduction. Our objective was to evaluate the effects of air pollution on ovarian reserve and outcomes of ovarian stimulation among young, healthy females. We included 472 oocyte donors who underwent 781 ovarian stimulation cycles at a fertility clinic in Atlanta, Georgia, USA (2008-2019). Antral follicle count (AFC) was assessed with transvaginal ultrasonography and total and mature oocyte count was assessed following oocyte retrieval. Ovarian sensitivity index (OSI) was calculated as the total number of oocytes divided by total gonadotrophin dose × 1000. Daily ambient exposure to nitric oxide (NOx), carbon monoxide (CO), and particulate matter ≤ 2.5 (PM2.5) was estimated using a fused regional + line-source model for near-surface releases at a 250 m resolution based on residential address. Generalized estimating equations were used to evaluate the associations of an interquartile range (IQR) increase in pollutant exposure with outcomes adjusted for donor characteristics, census-level poverty, and meteorological factors. The median (IQR) age among oocyte donors was 25.0 (5.0) years, and 31% of the donors were racial/ethnic minorities. The median (IQR) exposure to NOx, CO, and PM2.5 in the 3 months prior to stimulation was 37.7 (32.0) ppb, 612 (317) ppb, and 9.8 (2.9) µg/m3, respectively. Ambient air pollution exposure in the 3 months before AFC was not associated with AFC. An IQR increase in PM2.5 in the 3 months before AFC and during stimulation was associated with -7.5% (95% CI -14.1, -0.4) and -6.4% (95% CI -11.0, -1.6) fewer mature oocytes, and a -1.9 (95% CI -3.2, -0.5) and -1.0 (95% CI -1.8, -0.2) lower OSI, respectively. Our results suggest that lowering the current 24-h PM2.5 standard in the US to 25 µg/m3 may still not adequately protect against the reprotoxic effects of short-term PM2.5 exposure.

Observations of the chemistry and concentrations of reactive Hg at locations with different ambient air chemistry.

The Hg research community needs methods to more accurately measure atmospheric Hg concentrations and chemistry. The Reactive Mercury Active System (RMAS) uses cation exchange, nylon, and PTFE membranes to determine reactive mercury (RM), gaseous oxidized mercury, and particulate-bound mercury (PBM) concentrations and chemistry. New data for Atlanta, Georgia (NRGT) demonstrated that particulate-bound Hg was dominant and the chemistry was primarily N and S HgII compounds. At Great Salt Lake, Utah (GSL), RM was predominately PBM, with NS > organics > halogen > O HgII compounds. At Guadalupe Mountains National Park, Texas (GUMO), halogenated compound concentrations were lowest when air interacting with the site was primarily derived from the Midwest, and highest when the air was sourced from Mexico. At Amsterdam Island, Southern Indian Ocean, compounds were primarily halogenated with some N, S, and organic HgII compounds potentially associated with biological activity. The GEOS-Chem model was applied to see if it predicted measurements at five field sites. Model values were higher than observations at GSL, slightly lower at NRGT, and observations were an order of magnitude higher than modeled values for GUMO and Reno, Nevada. In general, data collected from 13 locations indicated that N, S, and organic RM compounds were associated with city and forest locations, halogenated compounds were sourced from the marine boundary layer, and O compounds were associated with long-range transport. Data being developed currently, and in the past, suggest there are multiple forms of RM that modelers must consider, and PBM is an important component of RM.

Assessment of light-duty versus heavy-duty diesel on-road mobile source emissions using general additive models applied to traffic volume and air quality data and COVID-19 responses.

Following the outbreak of the COVID-19 pandemic, several papers have examined the effect of the pandemic response on urban air pollution worldwide. This study uses observed traffic volume and near-road air pollution data for black carbon (BC), oxides of nitrogen (NOx), and carbon monoxide (CO) to estimate the emissions contributions of light-duty and heavy-duty diesel vehicles in five cities in the continental United States. Analysis of mobile source impacts in the near-road environment has several health and environmental justice implications. Data from the initial COVID-19 response period, defined as March to May in 2020, were used with data from the same period over the previous two years to develop general additive models (GAMs) to quantify the emissions impact of each vehicle class. The model estimated that light-duty traffic contributes 4-69%, 14-65%, and 21-97% of BC, NOx, and CO near-road levels, respectively. Heavy-duty diesel traffic contributes an estimated 26-46%, 17-63%, and -7-18% of near-road levels of the three pollutants. The estimated mobile source impacts were used to calculate NOx to CO and BC to NOx emission ratios, which were between 0.21-0.32 µg m-3 NOx (µg m-3 CO)-1 and 0.013-0.018 µg m-3 BC (µg m-3 NOx)-1. These ratios can be used to assess existing emission inventories for use in determining air pollution standards. These results agree moderately well with recent National Emissions Inventory estimates and other empirically-derived estimates, showing similar trends among the pollutants. However, a limitation of this study was the recurring presence of an implausible air pollution impact estimate in 41% of the site-pollutant combinations, where a vehicle class was estimated to account for either a negative impact or an impact higher than the total estimated pollutant concentration. The variations seen in the GAM estimates are likely a result of location-specific factors, including fleet composition, external pollution sources, and traffic volumes.Implications: Drastic reductions in traffic and air pollution during the lockdowns of the COVID-19 pandemic present a unique opportunity to assess vehicle emissions. A General Additive Modeling approach is developed to relate traffic levels, observed air pollution, and meteorology to identify the amount vehicle types contribute to near-road levels of traffic-related air pollutants (TRAPs), which is important for future emission regulation and policy, given the significant health and environmental justice implications of vehicle-related pollution along major roadways. The model is used to evaluate emission inventories in the near-road environment, which can be used to refine existing estimates. By developing a locally data-driven method to readily characterize impacts and distinguish between heavy and light duty vehicle effects, local regulations can be used to target policies in major cities around the country, thus addressing local health disbenefits and disparities occurring as a result of exposure to near-road air pollution.

Emissions and meteorological impacts on PM2.5 species concentrations in Southern California using generalized additive modeling.

The chemical composition of PM2.5 has a significant impact on human health and air quality, and its accurate knowledge can be used to identify contributing emission sources. Assessing and quantifying the impacts of various factors (e.g., emissions, meteorology, and large-scale climate patterns) on the main PM2.5 chemical components can give guidance for implementing effective regulations to improve air quality in the future. In this study, we developed generalized additive models (GAMs) to assess how emissions, meteorological factors, and large-scale climate indices affected ammonium, sulfate, nitrate, elemental carbon, and organic carbon from 2002 to 2019 in the South Coast Air Basin (SoCAB). Concentration trends from three sites in the SoCAB are studied. The statistical results showed that GAMs can capture the variability of these species' daily concentrations (R2 = 0.6 to 0.7) and annual concentrations (R2 = 0.93 to 0.99). Precursor emissions most significantly affect PM2.5 species production, though meteorological factors like maximum temperature, relative humidity, wind speed, and boundary layer height, also influence PM2.5 composition. In the future, these meteorological factors will become more significant in affecting PM2.5 speciation, although emissions will continue to strongly affect formation. Results show that the composition of most PM2.5 species will decrease in the future except for OC, which will become the largest contributor to PM2.5.

Abundant nitrogen oxide and weakly acidic environment synergistically promote daytime particulate nitrate pollution.

Nitrate is formed through the chemical production of gas-phase nitric acid and subsequent partitioning to the aerosol phase during the daytime. Many studies in the past separated these two aspects, even though they occur simultaneously in the atmosphere. To better understand the nitrate formation mechanism and effectively mitigate its production, it is necessary to consider the synergy between these two mechanisms. For this, we analyze hourly-speciated ambient observations data, with EK&TMA (Empirical Kinetic & Thermodynamic Modeling Approach) map to comprehensively explore the factors controlling nitrate production. Results show that precursor NO2 concentration and aerosol pH, which are related to anthropogenic activities, are the two major factors for chemical kinetics production and gas/particle thermodynamic partitioning processes respectively. Abundant NO2 and weakly acidic environments are favorable conditions for daytime particulate nitrate pollution, thus collaborative control of coal source, vehicle source, and dust source is needed to alleviate nitrate pollution.

Associations between source-apportioned PM2.5 and 30-day readmissions in heart failure patients.

BACKGROUND: Air pollution exposure is a significant risk factor for morbidity and mortality, especially for those with pre-existing chronic disease. Previous studies highlighted the risks that long-term particulate matter exposure has for readmissions. However, few studies have evaluated source and component specific associations particularly among vulnerable patient populations. OBJECTIVES: Use electronic health records from 5556 heart failure (HF) patients diagnosed between July 5, 2004 and December 31, 2010 that were part of the EPA CARES resource in conjunction with modeled source-specific fine particulate matter (PM2.5) to estimate the association between exposure to source and component apportioned PM2.5 at the time of HF diagnosis and 30-day readmissions. METHODS: We used zero-inflated mixed effects Poisson models with a random intercept for zip code to model associations while adjusting for age at diagnosis, year of diagnosis, race, sex, smoking status, and neighborhood socioeconomic status. We undertook several sensitivity analyses to explore the impact of geocoding precision and other factors on associations and expressed associations per interquartile range increase in exposures. RESULTS: We observed associations between 30-day readmissions and an interquartile range increase in gasoline- (16.9% increase; 95% confidence interval = 4.8%, 30.4%) and diesel-derived PM2.5 (9.9% increase; 95% confidence interval = 1.7%, 18.7%), and the secondary organic carbon component of PM2.5 (SOC; 20.4% increase; 95% confidence interval = 8.3%, 33.9%). Associations were stable in sensitivity analyses, and most consistently observed among Black study participants, those in lower income areas, and those diagnosed with HF at an earlier age. Concentration-response curves indicated a linear association for diesel and SOC. While there was some non-linearity in the gasoline concentration-response curve, only the linear component was associated with 30-day readmissions. DISCUSSION: There appear to be source specific associations between PM2.5 and 30-day readmissions particularly for traffic-related sources, potentially indicating unique toxicity of some sources for readmission risks that should be further explored.

Acute Effects of Ambient Air Pollution on Asthma Emergency Department Visits in Ten U.S. States.

BACKGROUND: Previous studies of short-term ambient air pollution exposure and asthma morbidity in the United States have been limited to a small number of cities and/or pollutants and with limited consideration of effects across ages. OBJECTIVES: To estimate acute age group-specific effects of fine and coarse particulate matter (PM), major PM components, and gaseous pollutants on emergency department (ED) visits for asthma during 2005-2014 across the United States. METHODS: We acquired ED visit and air quality data in regions surrounding 53 speciation sites in 10 states. We used quasi-Poisson log-linear time-series models with unconstrained distributed exposure lags to estimate site-specific acute effects of air pollution on asthma ED visits overall and by age group (1-4, 5-17, 18-49, 50-64, and 65+ y), controlling for meteorology, time trends, and influenza activity. We then used a Bayesian hierarchical model to estimate pooled associations from site-specific associations. RESULTS: Our analysis included 3.19 million asthma ED visits. We observed positive associations for multiday cumulative exposure to all air pollutants examined [e.g., 8-d exposure to PM2.5: rate ratio of 1.016 with 95% credible interval (CI) of (1.008, 1.025) per 6.3-µg/m3 increase, PM10-2.5: 1.014 (95% CI: 1.007, 1.020) per 9.6-µg/m3 increase, organic carbon: 1.016 (95% CI: 1.009, 1.024) per 2.8-µg/m3 increase, and ozone: 1.008 (95% CI: 0.995, 1.022) per 0.02-ppm increase]. PM2.5 and ozone showed stronger effects at shorter lags, whereas associations of traffic-related pollutants (e.g., elemental carbon and oxides of nitrogen) were generally stronger at longer lags. Most pollutants had more pronounced effects on children (<18 y old) than adults; PM2.5 had strong effects on both children and the elderly (>64 y old); and ozone had stronger effects on adults than children. CONCLUSIONS: We reported positive associations between short-term air pollution exposure and increased rates of asthma ED visits. We found that air pollution exposure posed a higher risk for children and older populations. https://doi.org/10.1289/EHP11661.

Catalytic CO2 Capture via Ultrasonically Activating Dually Functionalized Carbon Nanotubes.

High energy consumption and high cost have been the obstacles for large-scale deployment of all state-of-the-art CO2 capture technologies. Finding a transformational way to improve mass transfer and reaction kinetics of the CO2 capture process is timely for reducing carbon footprints. In this work, commercial single-walled carbon nanotubes (CNTs) were activated with nitric acid and urea under ultrasonication and hydrothermal methods, respectively, to prepare N-doped CNTs with the functional group of -COOH, which possesses both basic and acid functionalities. The chemically modified CNTs with a concentration of 300 ppm universally catalyze both CO2 sorption and desorption of the CO2 capture process. The increases in the desorption rate achieved with the chemically modified CNTs can reach as high as 503% compared to that of the sorbent without the catalyst. A chemical mechanism underlying the catalytic CO2 capture is proposed based on the experimental results and further confirmed by density functional theory computations.

Emissions, meteorological and climate impacts on PM2.5 levels in Southern California using a generalized additive model: Historic trends and future estimates.

Annual fine particulate matter (PM2.5) mass concentrations in the South Coast Air Basin (SoCAB) of California decreased from around 30 µg/m3 to 11 µg/m3 between 2000 and 2013 but rose from 11 µg/m3 to 13 µg/m3 between 2014 and 2018, raising important questions about the effectiveness of ongoing emission control policies. A two-step generalized additive model (GAM)-least squares approach was developed to explore the effects of emissions, large-scale climate events and meteorological factors on daily PM2.5 mass concentrations from 2000 to 2019 to quantitatively link impacts of emissions and meteorological on PM2.5 and to assess factors leading to the increase. The GAM had an R2 = 0.99 and root mean square error (RMSE) = 0.7 µg/m3 for the annual average PM2.5 concentrations. The two-step method had an R2 = 0.93 and RMSE = 4.07 µg/m3 for the 98th percentile 24-hr average PM2.5 concentrations. Variations in both emissions and relative humidity were of high importance compared with other included factors. Interactions of NH3 emissions with NOx and SO2 emissions, which lead to ammonium nitrate and sulfate aerosol formation, were the most important factors. Meteorological effects on PM2.5 explained the majority of the daily PM2.5 fluctuations. Emission changes (increases in SO2 and PM2.5) led to increases in predicted PM2.5 between 2014 and 2018. Predicted future PM2.5, using projected emissions and meteorological data from model simulations of representative concentration pathway (RCP) scenarios, are around 12 µg/m3 (annual) and 30 µg/m3 (98th percentile daily), which are both close to the current National Ambient Air Quality Standards (NAAQS) for PM2.5. Meteorological impacts on the predicted PM2.5 in future years lead to variations of ±2 µg/m3 for the annual average and ±5 µg/m3 for the 98th percentile daily level. Future climate changes lead to a probable year-to-year variation that will let PM2.5 levels in some years exceed the standard.

[EMmim][NTf2 ]-a Novel Ionic Liquid (IL) in Catalytic CO2 Capture and ILs' Applications.

Ionic liquids (ILs) have been used for carbon dioxide (CO2 ) capture, however, which have never been used as catalysts to accelerate CO2 capture. The record is broken by a uniquely designed IL, [EMmim][NTf2 ]. The IL can universally catalyze both CO2 sorption and desorption of all the chemisorption-based technologies. As demonstrated in monoethanolamine (MEA) based CO2 capture, even with the addition of only 2000 ppm IL catalyst, the rate of CO2 desorption-the key to reducing the overall CO2 capture energy consumption or breaking the bottleneck of the state-of-the-art technologies and Paris Agreement implementation-can be increased by 791% at 85 °C, which makes use of low-temperature waste heat and avoids secondary pollution during CO2 capture feasible. Furthermore, the catalytic CO2 capture mechanism is experimentally and theoretically revealed.

Incident dementia and long-term exposure to constituents of fine particle air pollution: A national cohort study in the United States.

Growing evidence suggests that fine particulate matter (PM2.5) likely increases the risks of dementia, yet little is known about the relative contributions of different constituents. Here, we conducted a nationwide population-based cohort study (2000 to 2017) by integrating the Medicare Chronic Conditions Warehouse database and two independently sourced datasets of high-resolution PM2.5 major chemical composition, including black carbon (BC), organic matter (OM), nitrate (NO3-), sulfate (SO42-), ammonium (NH4+), and soil dust (DUST). To investigate the impact of long-term exposure to PM2.5 constituents on incident all-cause dementia and Alzheimer's disease (AD), hazard ratios for dementia and AD were estimated using Cox proportional hazards models, and penalized splines were used to evaluate potential nonlinear concentration-response (C-R) relationships. Results using two exposure datasets consistently indicated higher rates of incident dementia and AD for an increased exposure to PM2.5 and its major constituents. An interquartile range increase in PM2.5 mass was associated with a 6 to 7% increase in dementia incidence and a 9% increase in AD incidence. For different PM2.5 constituents, associations remained significant for BC, OM, SO42-, and NH4+ for both end points (even after adjustments of other constituents), among which BC and SO42- showed the strongest associations. All constituents had largely linear C-R relationships in the low exposure range, but most tailed off at higher exposure concentrations. Our findings suggest that long-term exposure to PM2.5 is significantly associated with higher rates of incident dementia and AD and that SO42-, BC, and OM related to traffic and fossil fuel combustion might drive the observed associations.

Chemical looping based ammonia production-A promising pathway for production of the noncarbon fuel.

Ammonia, primarily made with Haber-Bosch process developed in 1909 and winning two Nobel prizes, is a promising noncarbon fuel for preventing global warming of 1.5 °C above pre-industrial levels. However, the undesired characteristics of the process, including high carbon footprint, necessitate alternative ammonia synthesis methods, and among them is chemical looping ammonia production (CLAP) that uses nitrogen carrier materials and operates at atmospheric pressure with high product selectivity and energy efficiency. To date, neither a systematic review nor a perspective in nitrogen carriers and CLAP has been reported in the critical area. Thus, this work not only assesses the previous results of CLAP but also provides perspectives towards the future of CLAP. It classifies, characterizes, and holistically analyzes the fundamentally different CLAP pathways and discusses the ways of further improving the CLAP performance with the assistance of plasma technology and artificial intelligence (AI).

Application of an Improved Gas-constrained Source Apportionment Method Using Data Fused Fields: a Case Study in North Carolina, USA.

A number of studies have found differing associations of disease outcomes with PM2.5 components (or species) and sources (e.g., biomass burning, diesel vehicles and gasoline vehicles). Here, a unique method of fusing daily chemical transport model (Community Multiscale Air Quality Modeling) results with observations has been utilized to generate spatiotemporal fields of the concentrations of major gaseous pollutants (CO, NO2, NOx, O3, and SO2), total PM2.5 mass, and speciated PM2.5 (including crustal elements) over North Carolina for 2002-2010. The fused results are then used in chemical mass balance source apportionment model, CMBGC-Iteration, which uses both gas constraint and particulate matter concentrations to quantify source impacts. The method, as applied to North Carolina, quantifies the impacts of ten source categories and provides estimates of source contributions to PM2.5 concentrations. The ten source categories include both primary sources (diesel vehicles, gasoline vehicles, dust, biomass burning, coal-fired power plants and sea salt) and secondary components (ammonium sulfate, ammonium bisulfate, ammonium nitrate and secondary organic carbon). The results show a steady decrease in anthropogenic source impacts, especially from diesel vehicles and coal-fired power plants. Secondary pollutant components accounted for approximately 70% of PM2.5 mass. This study demonstrates an ability to provide spatiotemporal fields of both PM components and source impacts using a chemical transport model fused with observation data, linked to a receptor-based source apportionment method, to develop spatiotemporal fields of multiple pollutants.

Targeting Atmospheric Oxidants Can Better Reduce Sulfate Aerosol in China: H2O2 Aqueous Oxidation Pathway Dominates Sulfate Formation in Haze.

Particulate sulfate is one of the most important components in the atmosphere. The observation of rapid sulfate aerosol production during haze events provoked scientific interest in the multiphase oxidation of SO2 in aqueous aerosol particles. Diverse oxidation pathways can be enhanced or suppressed under different aerosol acidity levels and high ionic strength conditions of atmospheric aerosol. The importance of ionic strength to sulfate multiphase chemistry has been verified under laboratory conditions, though studies in the actual atmosphere are still limited. By utilizing online observations and developing an improved solute strength-dependent chemical thermodynamics and kinetics model (EF-T&K model, EF is the enhancement factor that represents the effect of ionic strength on an aerosol aqueous-phase reaction), we provided quantitative evidence that the H2O2 pathway was enhanced nearly 100 times and dominated sulfate formation for entire years (66%) in Tianjin (a northern city in China). TMI (oxygen catalyzed by transition-metal ions) (14%) and NO2 (14%) pathways got the second-highest contributions. Machine learning supported the result that aerosol sulfate production was more affected by the H2O2 pathway. The collaborative effects of atmospheric oxidants and SO2 on sulfate aerosol production were further investigated using the improved EF-T&K model. Our findings highlight the effectiveness of adopting target oxidant control as a new direction for sustainable mitigation of sulfate, given the already low SO2 concentrations in China.

Impact of Circular, Waste-Heat Reuse Pathways on PM2.5-Air Quality, CO2 Emissions, and Human Health in India: Comparison with Material Exchange Potential.

India is home to 1.3 billion people who are exposed to some of the highest levels of ambient air pollution in the world. In addition, India is one of the fastest-growing carbon-emitting countries. Here, we assess how two strategies to reuse waste-heat from coal-fired power plants and other large sources would impact PM2.5-air quality, human health, and CO2 emissions in 2015 and a future year, 2050, using varying levels of policy adoption (current regulations, proposed single-sector policies, and ambitious single-sector strategies). We find that power plant and industrial waste-heat reuse as input to district heating systems (DHSs), a novel, multisector strategy to reduce local biomass burning for heating emissions, can offset 71.3-85.2% of residential heating demand in communities near a power plant (9.3-12.4% of the nationwide heating demand) with the highest benefits observed during winter months in areas with collocated industrial activity and higher residential heating demands (e.g., New Delhi). Utilizing waste-heat to generate electricity via organic Rankine cycles (ORCs) can generate an additional 22 (11% of total coal-fired generating capacity), 41 (8%), 32 (13%), and 6 (5%) GW of electricity capacity in the 2015, 2050-current regulations, 2050-single-sector, and 2050-ambitious-single-sector scenarios, respectively. Emission estimates utilizing these strategies were input to the GEOS-Chem model, and population-weighted, simulated PM2.5 showed small improvements in the DHS (0.2-0.4%) and ORC (0.3-3.4%) scenarios, where the minimal DHS PM2.5-benefit is attributed to the small contribution of biomass burning for heating to nationwide PM2.5 emissions (much of the biomass burning activity is for cooking). The PM2.5 reductions lead to ∼130-36,000 mortalities per year avoided among the scenarios, with the largest health benefits observed in the ORC scenarios. Nationwide CO2 emissions reduced <0.04% by DHSs but showed larger reductions using ORCs (1.9-7.4%). Coal fly-ash as material exchange in cement and brick production was assessed, and capacity exists to completely reutilize unused fly-ash toward cement and brick production in each of the scenarios.