Despite substantial reductions in nitrogen oxide (NOx) emissions in the United States, the success of emission control programs in optimal ozone reduction is disputable because they do not consider the spatial and temporal differences in health and environmental damages caused by NOx emissions. This shortcoming in the current U.S. NOx control policy is explored, and various methodologies for identifying optimal NOx emission control strategies are evaluated. The proposed approach combines an optimization platform with an adjoint (or backward) sensitivity analysis model and is able to examine the environmental performance of the current cap-and-trade policy and two damage-based emissions-differentiated policies. Using the proposed methodology, a 2007 case study of 218 U.S. electricity generation units participating in the NOx trading program is examined. The results indicate that inclusion of damage information can significantly enhance public health performance of an economic instrument. The net benefit under the policy that minimizes the social cost (i.e., health costs plus abatement costs) is six times larger than that of an exchange rate cap-and-trade policy.