Fire smoke is a major contributor to both particulate matter (PM) and ozone exposure in urban centers. Epidemiological, clinical, and toxicological studies have demonstrated a casual relationship between these pollutants and cardiovascular and respiratory related deaths and illnesses. Given the expected increase in fire events due to climate and landscape changes, quantifying health effects of wildfire smoke and developing real-time tools to help air quality managers mitigate the effects of exposure are sorely needed. We comprehensively assessed the health risks posed by smoke exposure, and constructed new tools to estimate and forecast smoke concentration levels and associated health effects. We accomplished these goals with four specific aims. In Aim 1, we compared the chemical composition of fine PM emanating from fire smoke with typical urban PM in the US. This information fills an important gap in the literature, and enabled us to distinguish between smoke and non-smoke related exposures in air quality indices and epidemiological studies. In Aim 2, we conducted a systematic review and meta analysis of the risk estimates to evaluate the risks of smoke exposure for all relevant health outcomes. Using these pooled risk estimates of the health effects of smoke exposure, in Aim 3 we utilized the BenMAP-CE air pollution tool to characterize the health and economic value of the effects of fire smoke, such as the number of asthma exacerbations or hospital admissions and the associated economic cost. Finally, in Aim 4 we combined model-based predicted smoke exposure with health and economic assessment tools to provide real-time forecasts of health risk over space and time. This new tool provides easily interpretable information to assist officials in their decision processes to mitigate health effects, such as issuing hourly targeted advisories. To accomplish these tasks, we assembled a diverse team from US and Australian research institutions and government with extensive experience in air quality modeling, biostatistics, economics, and epidemiology. In this report, we describe the results of this work and their impact on the field.