Air Quality Index and air quality awareness among adults in the United States
Introduction
Poor ambient air quality is associated with exacerbations of asthma and chronic obstructive pulmonary disease (COPD) (Metzger et al., 2004; Meng et al., 2007; DeVries et al., 2017), respiratory and cardiovascular-related hospitalization (Bell et al., 2008; Belleudi et al., 2010), and death (Krewski et al., 2009). In fact, air pollution is estimated to have contributed to nearly 1 in every 10 deaths globally, leading it to be ranked fifth among global risk factors for mortality in 2017 (Health Effects Institute, 2019). Despite these well-documented associations, there is little evidence that our epidemiologic understanding of the hazards of exposure to poor air quality has translated widely into increased awareness or changes in behavior to reduce air pollution exposure among populations most at risk and their health care providers (Borbet et al., 2018; Mirabelli et al., 2018).
In 2018, we reported that 49% of U.S. adults were aware of air quality alerts where they live, 3% had discussed with a health professional strategies to reduce air pollution exposure, and 27% always or usually avoided busy roads to reduce air pollution exposure when walking, biking, or exercising outdoors (Mirabelli et al., 2018). Each of the three outcomes was more common among adults with than without existing respiratory disease. Variations in awareness of air quality alerts by sociodemographic characteristics, in particular, suggest that targeting messages about air quality might raise awareness about air quality alerts and motivate adults to change their behaviors to reduce air pollution exposure during periods of unhealthy air quality (Mirabelli et al., 2018). In 2019, Pennington et al. reported that television was the most common communication channel by which adults receive air quality alerts, regardless of their existing respiratory or heart disease status (Pennington et al., 2019). Together, these findings reveal opportunities for improving awareness of air quality alerts among adults during periods of poor air quality. However, the role of actual air quality, as indicated by the Environmental Protection Agency's (EPA's) Air Quality Index, in the observed differences in awareness of air quality alerts and changes in behavior to reduce air pollution exposures remains unknown.
Broadly speaking, ambient air quality and the Air Quality Index in the United States is driven largely by ambient concentrations of ground-level ozone and particle pollution (U.S. Environmental Protection Agency, 2016). Ground-level ozone is created by reactions between oxides of nitrogen and volatile organic compounds, in the presence of sunlight. Oxides of nitrogen and volatile organic compounds are emitted by vehicles, power plants, and other industrial processes (U.S. Environmental Protection Agency, 2018b). In contrast, particle pollution, which includes particulate matter ≤2.5 μm and ≤10 μm in diameter, can be emitted directly (e.g., from construction sites, smoke stacks, fires) or can form from pollutants emitted from power plants, industrial facilities, and vehicles (U.S. Environmental Protection Agency). Fires and emissions can also contribute to episodic and local or regional spikes in particle pollution. Additional information about sources and trends of ambient air pollution in the United States are publicly available from the U.S. Environmental Protection Agency's National Emissions Inventory (U.S. Environmental Protection Agency, 2018a).
In the United States, air quality alerts such as the EPA Air Quality Index are used to inform the public when air quality is likely to affect the health of sensitive individuals, including those with heart or lung disease (U.S. Environmental Protection Agency, 2016; U.S. Environmental Protection Agency, 2019). The Air Quality Index is a six-category index that translates daily air pollutant measurements into information to help people understand their local air quality, its associated health risks, and actions they can take to protect their health (U.S. Environmental Protection Agency, 2016; U.S. Environmental Protection Agency, 2019). To date, little information is available about the Air Quality Index alerts and the public's awareness of air quality. To address this gap, we evaluated associations between days with Air Quality Index ≥101, corresponding to a categorization of air quality as unhealthy for sensitive groups, unhealthy, very unhealthy, or hazardous, and three measures of air quality awareness, as indicated by responses to survey questions about awareness of air quality alerts, perception of air quality, and behavior change because of air quality, in a sample of U.S. adults, and describe the prevalences of air quality awareness among adults with and without respiratory and heart disease.
Section snippets
Study population
We analyzed data from the summer 2016, 2017, and 2018 waves of the ConsumerStyles surveys, conducted by Porter Novelli Public Services (Washington, DC). Each year, ConsumerStyles surveys are conducted in the spring, summer, and fall to assess health-related knowledge and behaviors among adults in the United States. For each year included in our analysis, the spring wave of the ConsumerStyles survey (hereafter, “SpringStyles”) was conducted as a cross-sectional survey of a random sample of
Results
Characteristics of the 12,396 U.S. adults in our final study population are shown in Table 1. When survey responses were linked by county and survey year with publicly-available Air Quality Index data, we found that respondents spent an average of 238 days of the previous year with an Air Quality Index in the range of 0–50 (i.e., good), 98 days with an Air Quality Index in the range of 51–100 (i.e., moderate), and 15 days with an Air Quality Index ≥101 (i.e., unhealthy for sensitive groups,
Discussion
Using data from a 2016–2018 survey of adults in the United States, we investigated whether ambient air quality, as indicated by the Air Quality Index, affects air quality awareness among adults in the United States and found that increasing numbers of days with poor air quality is associated with increasing awareness of air quality alerts, perception of air quality, and behavior change because of poor air quality. Furthermore, each aspect of air quality awareness was higher among in adults in
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
The authors declare they have no competing financial interests.
Acknowledgements
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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