Eruptive activity at the Kīlauea volcano (Hawai`i, USA) has increased since 2008 resulting in volcanic air pollution (vog) at levels exceeding the national air quality standard for sulfur dioxide. Previous investigations during lower vog levels found adverse cardiorespiratory effects in the residents. The purpose of this 2012 survey was to reassess and compare the impact of the increased volcanic activity on population health. Prevalence of cardiorespiratory signs, symptoms, and diseases was estimated in vog exposed and unexposed communities, and descriptions of perceived health and environmental effects were collected door-to-door. Vog exposure was significantly associated with increased odds of self-reported cough, phlegm, rhinorrhea, sore/dry throat, shortness of breath, sinus congestion, continual wheezing, eye and skin irritation, and diagnosed hypertension. Field measurements identified significantly higher average systolic and diastolic blood pressures ( ) and lower blood oxygen saturation ( ). Half of the participants perceived that Kīlauea’s intensified eruption had negatively affected their health with reports of financial impacts from degradation of agriculture and livestock. Relatively stronger magnitudes of health effects were associated with the higher exposure to vog. Public concerns remain about attributed effects of the ongoing eruption. Enhanced public health efforts are recommended at Kīlauea and other degassing volcanoes worldwide. 1. Introduction Volcanic emissions have detrimental impacts on the environment and pose numerous hazards to humans. Explosive eruptions have associated mortality and adverse effects from ash fall, whereas effusive eruptions create insidious health risks from the passive degassing of emissions into the lower troposphere [1]. An estimated 9% of the world’s population live ≤100？km of a historically active volcano [2]. Therefore, it is imperative to gain an understanding of human-environmental interactions, identify health effects, and develop public health interventions for vulnerable populations exposed to volcanic air pollution. Effusive eruption at the Kīlauea volcano on the island of Hawai`i has persisted since 1986 from various vents on the volcano’s east rift zone. Emissions are predominantly water vapor mixed with carbon dioxide and sulfur dioxide (SO2), finely-sized sulfurous particles (PM2.5; primarily sulfuric acid aerosol), and trace gases of hydrogen sulfide, hydrogen fluoride, mercury, other halogens, and trace metals [3, 4]. As SO2 gas oxidizes to sulfate particles through various chemical and
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