Fay Johnston

University of Tasmania · Menzies Research Institute

One of the important adverse impacts of climate change on human health is increases in allergic respiratory diseases such as allergic rhinitis and asthma. This impact is via the effects of increases in atmospheric carbon dioxide concentration and air temperature on sources of airborne allergens such as pollen and fungal spores. This review describe...

Introduction: Healthcare facilities are high-risk settings for coronavirus disease 2019 (COVID-19) transmission. Early in the COVID-19 pandemic, the first large healthcare-associated outbreak within Australia occurred in Tasmania. Several operational research studies were conducted amongst workers from the implicated hospital campus, to learn more...

Background Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia t...

Background Bushfire smoke is a major ongoing environmental hazard in Australia. In the summer of 2019-2020 smoke from an extreme bushfire event exposed large populations to high concentrations of particulate matter (PM) pollution. In this study we aimed to estimate the effect of bushfire-related PM of less than 2.5 μ m in diameter (PM2.5) on the ri...

Background Air pollution is associated with cardiovascular disease and mortality. Most studies have focussed on urban or traffic-related pollution, and less is known about the impacts from bushfire smoke on cardiovascular autonomic function, although it is associated with increased sudden cardiac death and mortality. We sought to investigate its in...

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020 and 2021. It examines five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co...

Extreme heat and poor air quality arising from landscape fires are an increasing global concern driven by anthropogenic climate change. Previous studies have shown these environmental conditions are associated with negative health outcomes for vulnerable people. Managing and adapting to these conditions in a warming climate can present substantial...

Background & aims: Over the past decades, particulate matter (PM), especially fine PM <2.5 μm in aerodynamic diameter (PM2.5) has been a major research focus. However, the air pollutant is a mixture of gases or vapour-phase compounds, such as carbon monoxide (C), nitrogen oxides (NOx), photochemical oxidants (Ox), and sulfur dioxide (SO2). Little...

Autoantibodies to multiple targets are found during acute COVID-19. Whether all, or some, persist after 6 months, and their correlation with sustained anti-SARS-CoV-2 immunity, is still controversial. Herein, we measured antibodies to multiple SARS-CoV-2 antigens (Wuhan-Hu-1 nucleoprotein (NP), whole spike (S), spike subunits (S1, S2 and receptor b...

Colonialism has disrupted Indigenous socioecological systems around the globe, including those supported by intentional landscape burning. Because most disruptions happened centuries ago, our understanding of Indigenous fire management is largely inferential and open to debate. Here, we investigate the ecological consequences of the loss of traditi...

Savanna fire management is a topic of global debate, with early dry season burning promoted as a large-scale emissions reduction opportunity. To date, discussions have centred on carbon abatement efficacy, biodiversity and cultural benefits and/or risks. Here we use a case study of Darwin, Australia to highlight smoke pollution as another critical...

Introduction By subsidising access to direct acting antivirals (DAAs) for all people living with hepatitis C (HCV) in 2016, Australia is positioned to eliminate HCV as a public health threat. However, uptake of DAAs has declined over recent years and new initiatives are needed to engage people living with HCV in care. Active follow-up of HCV notifi...

Background While the relationship between outdoor particulate matter (PM) and lower respiratory tract infections in children and adolescents is accepted, we know little about the impacts of outdoor PM on the risk of developing or aggravating upper respiratory tract infections (URTIs). Methods We aimed to review the literature examining the relatio...

Background Public transport users often accumulate more physical activity than motor vehicle users, but most studies have been conducted in large metropolitan areas with multiple public transport options with limited knowledge of the relationship in regional and rural areas. In a regional city, this pilot study aimed to (1) test the feasibility of...

Background: Little is known about the long-term health impacts of exposures to landscape fire smoke. We aimed to evaluate the association between exposure to coal mine fire-related particulate matter 2.5 lm or less in diameter (PM 2.5) and hospitalisation in the 5 years following the 6-week Hazelwood coal mine fire in Australia in 2014. Methods: W...

Pollen allergies are responsible for a considerable global public health burden, and understanding exposure is critical to addressing the health impacts. Atmospheric pollen counts are routinely used as a predictor of risk; however, immune responses are triggered by specific proteins known as allergens, which occur both within and on the surface of...

Background Asthma epidemics associated with thunderstorms have had catastrophic impacts on individuals and emergency services. Seasonal allergic rhinitis (SAR) is present in the vast majority of people who develop thunderstorm asthma (TA), but there is little evidence regarding risk factors for TA among the SAR population. Objective We sought to i...

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilie...

Background Smoke from uncontrolled wildfires and deliberately set prescribed burns has the potential to produce substantial population exposure to fine particulate matter (PM2·5). We aimed to estimate historical health costs attributable to smoke-related PM2·5 from all landscape fires combined, and the relative contributions from wildfires and pres...

Background Little is known about the long-term health effects of coalmine fire smoke exposure. The 2014 Hazelwood coalmine fire event in southeast Australia released smoke into surrounding areas for 6 weeks. Objectives We aimed to investigate whether individual-level exposure to coalmine fire-related PM2.5 was associated with a long-term increase...

Objectives To estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale. Design Health impact assessment (excess annual mortality and financial costs) based upon atmospheric PM2.5 measurements. Setting Armidale, a regional Australian city (population, 24 504) with high leve...

Background Climate change is causing an increase in the frequency and severity of heatwave events, with a corresponding negative impact on human health. Health service utilisation during a heatwave is increased, with a greater risk of poor health outcomes identified for specific population groups. In this study, we examined the impact of heatwave e...

Background and objective: The link between respiratory and vascular health is well documented in adult populations. Impaired lung function is consistently associated with thicker arteries and higher incidence of cardiovascular disease. However, there are limited data on this relationship in young children and the studies that exist have focussed o...

Pollen is a well-established trigger of asthma and allergic rhinitis, yet concentration-response relationships, lagged effects, and interactions with other environmental factors remain poorly understood. Smartphone technology offers an opportunity to address these challenges using large, multi-year datasets that capture individual symptoms and expo...

During extreme air pollution events, such as bushfires, public health agencies often recommend that vulnerable individuals visit a nearby public building with central air conditioning to reduce their exposure to smoke. However, there is limited evidence that these “cleaner indoor air shelters” reduce exposure or health risks. We quantified the impa...

Objective The aim of this study was to quantify the direct and indirect costs of asthma and allergic rhinitis (AR) for 2018 in Tasmania.Methods We used publicly available data, and Tasmanian-specific values where available, to estimate direct and indirect costs of both diseases. Direct costs included outcomes such as emergency department (ED) prese...

AirRater is a free smartphone app developed in 2015, supporting individuals to protect their health from environmental hazards. It does this by providing (i) location-specific and near real-time air quality, pollen and temperature information and (ii) personal symptom tracking functionality. This research sought to evaluate user perceptions of AirR...

In flammable landscapes around the globe, longer fire seasons with larger, more severely burnt areas are causing social and economic impacts that are unsustainable. The Australian 2019–20 fire season is emblematic of this trend, burning over 8 million ha of predominately Eucalyptus forests over a six-month period. We calculated the wildfire-smoke-r...

Ambient fine particulate matter <2.5 µm (PM2.5) air pollution increases premature mortality globally. Some PM2.5 is natural, but anthropogenic PM2.5 is comparatively avoidable. We determined the impact of long-term exposures to the anthropogenic PM component on mortality in Australia. PM2.5-attributable deaths were calculated for all Australian Sta...

Waste-to-energy (WtE) processes, or the combustion of refuse-derived fuel (RDF) for energy generation, has the potential to reduce landfill volume while providing a renewable energy source. We aimed to systematically review and summarise current evidence on the potential health effects (benefits and risks) of exposure to WtE/RDF-related combustion...

• The MJA–Lancet Countdown on health and climate change was established in 2017, and produced its first Australian national assessment in 2018 and its first annual update in 2019. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions...

Background Victoria is a state in south-eastern Australia with a population of 6.6 million people. The 21st of November 2019 was the start of an unprecedented forest fire season during which 1.5 million hectares were burnt in Victoria. The fires were preceded by record fire danger weather in Australia and smoke affected large populations for a long...

Background: Emergency services working to protect communities from harm during wildfires aim to provide regular public advisories on the hazards from fire and smoke. However, there are few studies evaluating the success of public health communications regarding the management of smoke exposure. We explored the responses to smoke-related health advi...

Background In the southern hemisphere summer of 2019-2020, Australia experienced its most severe bushfire season on record. Smoke from fires affected 80% of the population, with large exceedances of the Australian National Air Quality Standard for particulate air pollution recorded in all major population centres during this period. We examined if...

Objective To evaluate associations between exposure during early life to mine fire smoke and parent‐reported indicators of respiratory and atopic illness 2–4 years later. Design, setting The Hazelwood coalmine fire exposed a regional Australian community to markedly increased air pollution during February – March 2014. During June 2016 – October 2...

In the southern hemisphere summer of 2019–20, Australia experienced its most severe bushfire season on record. Smoke from fires affected 80% of the population, with large and prolonged exceedances of the Australian National Air Quality Standard for fine particulate matter (PM2.5) recorded in all major population centers. We examined if AirRater, a...

Vegetation fires are an essential component of the Earth system but can also cause substantial economic losses, severe air pollution, human mortality and environmental damage. Contemporary fire regimes are increasingly impacted by human activities and climate change, but, owing to the complex fire–human–climate interactions and incomplete historica...

Walking to more distant public transport stops is commonly promoted for physical activity gain. We examined the uptake of, and reasons for, this behaviour and its correlates through a cross-sectional survey (n = 944) and independent interview study (n = 22). Quantitative analysis examined correlates of frequency of walking to more distant bus stops...

BACKGROUND: Exposure to fine particulate matter (PM 2:5) during wildfire seasons has been associated with adverse health outcomes. Previous studies have focused on daily exposure, but PM 2:5 levels in smoke events can vary considerably within 1 d. OBJECTIVES: We aimed to assess the immediate and lagged relationship between sub-daily exposure to P...

The island state of Tasmania has marked seasonal variations of fine particulate matter (PM2.5) concentrations related to wood heating during winter, planned forest fires during autumn and spring, and bushfires during summer. Biomass smoke causes considerable health harms and associated costs. We estimated the historical health burden from PM2.5 att...

Aims: We investigated the effects of exposure to very low levels of particulate matter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) on coronary calcium score (CCS) in asymptomatic adults who are free of coronary artery disease (CAD). Methods and results: This study included 606 asymptomatic adults (49% men, aged 56±7 years) recruited from communit...

Asthma and allergic rhinitis (or hay fever) are ubiquitous, chronic health conditions that seasonally affect a sizeable proportion of the population. Both are commonly triggered or exacerbated by environmental conditions including aeroallergens, air quality and weather. Smartphone technology offers new opportunities to identify environmental driver...

Heat-related extreme events, such as wildfires and heatwaves, have historically imposed a burden on Australian society, and according to rigorous and robust scientific literature, it is expected that there will be an increase in frequency, intensity and duration of these types of natural hazards. Within Australia, wildfires and heatwaves are curren...

Background: PM2·5 is an important but modifiable environmental risk factor, not only for pulmonary diseases and cancers, but for cardiovascular health. However, the evidence regarding the association between air pollution and acute cardiac events, such as out-of-hospital cardiac arrest (OHCA), is inconsistent, especially at concentrations lower th...

Objective To evaluate whether vascular health in young children was associated with exposure to a 6-week episode of coal mine fire smoke or environmental tobacco smoke (ETS) in a retrospective cohort study. Methods Three years after a coal mine fire in Victoria, Australia, we investigated the vascular health of children either in utero (n=75) or a...

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics an...

Background: In 2014, the Hazelwood coal mine fire was an unprecedented event that resulted in a six-week period of poor air quality in the Latrobe Valley in regional Australia. We aimed to determine whether maternal exposure to fine particulate matter in coal mine fire smoke was associated with selected obstetric complications, including gestation...

Background: This study assessed the association between coal-mine-fire-related fine particulate matter (PM2.5) and medical-service utilization, following a 6-week coal-mine fire in Australia, in 2014. Areas in the immediate vicinity of the mine experienced hourly mine-fire-related PM2.5 concentrations of up to 3700 μg/m3. Methods: Data on medica...

Heatwaves have been identified as a threat to human health, with this impact projected to rise in a warming climate. Gaps in local knowledge can potentially undermine appropriate policy and preparedness actions. Using a case-crossover methodology, we examined the impact of heatwave events on hospital emergency department (ED) presentations in the t...

Background: Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited. Objectives: We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM2.5) from coal mine fire emissions and the frequencies of general practitioner attendance...

Introduction Accumulating evidence has shown the elevated risk for cardiovascular diseases (CVD) with exposure to air pollution, such as fine particles <2.5μm in aerodynamic diameter (PM2.5). A bi-directional relationship exists between air pollution and traditional CV risk factors like obesity, diabetes, and hypertension. However, little is known...

Introduction The cardiovascular health consequences of ambient air pollution generally equal or exceed those due to pulmonary diseases and cancers. Particulate matter less than 2.5μm in aerodynamic diameter (PM2.5) has become a major focus of research on the short-term exposure to air pollution and cardiovascular disease. However, the evidence rega...

Background: Asthma-related outcomes are regularly used by studies to investigate the association between human exposure to landscape fire smoke and health. Robust summary effect estimates are required to inform health protection policy for fire smoke exposure. Objective: To conduct a systematic review and meta-analysis to estimate the associatio...

Background: Asthma-related outcomes are among the most reported from human exposure to landscape fire smoke. Robust summary estimates are required to adequately inform health protection policy. Objective: To obtain summary estimates of the association between fine particulate matter (PM2.5) from landscape fire smoke and asthma-related outcomes. M...

Indigenous children have much higher rates of ear and lung disease than non-Indigenous children, which may be related to exposure to high levels of geogenic (earth-derived) particulate matter (PM). The aim of this study was to assess the relationship between dust levels and health in Indigenous children in Western Australia (W.A.). Data were from a...

Background and objective: Long-term respiratory risks following exposure to relatively short periods of poor air quality early in life are unknown. We aimed to evaluate the association between exposure to a 6-week episode of air pollution from a coal mine fire in children aged <2 years, and their lung function 3 years after the fire. Methods: We...

Epidemic thunderstorm asthma (ETA) is an emerging public health threat in Australia, highlighted by the 2016 event in Melbourne, Victoria, that overwhelmed health services and caused loss of life. However, there is limited understanding of the regional variations in risk. We evaluated the public health risk of ETA in the nearby state of Tasmania by...

This systematic review aimed to summarize epidemiologic evidence regarding long-term effects of prenatal and infant particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) exposure on wheezing and asthma. Methods: Epidemiologic data investigating the associations between ambient PM2.5 exposures during prenatal or the first 2 year...

Bushfires, prescribed burns and residential wood burning are a significant source of fine particles (PM2.5) affecting the health and well-being of many communities. Despite the lack of evidence, a common public health recommendation is to remain indoors assuming that the home provides a protective barrier against ambient PM2.5. The study aimed to a...

The extensible Biomass Smoke Validated Events Database is an ongoing, community driven, collection of air pollution events which are known to be caused by vegetation fires such as bushfires (also known as wildfire and wildland fires), or prescribed fuel reduction burns, and wood heaters. This is useful for researchers of health impacts who need to...