Years before Janice Nolen began keeping tabs on the nation’s air quality for the American Lung Association, her mother used to tell her about air pollution in her native Nashville that was so bad that people brought an extra shirt to work so they’d have a clean one to change into.

By 1993, those days seemed to be in the past. The major amendments to the U.S. Clean Air Act that passed in 1970 had been at work for decades, and the air was visibly cleaner. So it was a shock to Nolen —today the Lung Association’s assistant vice president of national policy and advocacy—when Harvard School of Public Health researchers highlighted still deadly air pollution in the small city of Harriman, Tennessee that was taking years from people’s lives.

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