Perception Matters: Perceived vs. Objective Air Quality Measures and Asthma Diagnosis among Urban Adults.

Urban air pollution is consistently linked to poorer respiratory health, particularly in communities of lower socioeconomic position (SEP), disproportionately located near highways and industrial areas and often with elevated exposures to chronic psychosocial stressors. Fewer studies, however, have considered air pollution itself as a psychosocial stressor and whether pollution may be impacting health through both direct physiologic and psychosocial pathways. We examined data on perceived air pollution exposures from a spatially representative survey of New York City adults through summer and winter 2012 (n = 1183) using residence-specific ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) exposure estimates. We used logistic regression to compare associations for perceived and objective air quality on self-reported asthma and general health, adjusting for sociodemographics and mental health. In models including all exposure metrics, we found small but significant associations for perceived air quality (OR = 1.12, 95% CI: 1.04-1.22) but not for NO2 or PM2.5. Neither perceived nor objective pollution was significantly associated with self-reported general health. Results suggest that perceived air quality may be significantly associated with adult asthma, more so than objective air pollution and after adjusting for mental health-associations not observed for self-reported general health.

Provider perceptions of mHealth engagement for low-resourced, safety-net communities.

OBJECTIVE: Evaluate nurses' and other health care professionals' (HCPs) perceptions about implementing mobile health technology (mHealth) in clinical practice to support health care delivery for low-resourced, safety-net communities. DESIGN: Qualitative exploratory study using data collected from focus group sessions. Respondents addressed four topics: (1) technology's role in health care delivery; (2) barriers to incorporating mHealth data in clinical practice; (3) need for mHealth Clinical Practice Guide (CPG); and (4) mHealth's potential to improve health care access for marginalized communities. SAMPLE: Thirty HCPs providing services to community health center patients in Washington State and Washington, DC. MEASUREMENTS: Thematic analysis of qualitative data. RESULTS: Themes included:(1) mHealth's ability to provide customized reminders and data accuracy; (2) patients' mistrust of technology; (3) the possibility of linking community resources to address the social determinants of health;(4) mHealth's potential to improve patient-provider communication. CONCLUSION: Health care professionals support incorporating mHealth inpatient care but suggest that an mHealth CPG would improve its potential for facilitating health care delivery in low-resourced communities.

Smoke-Free Outdoor Seating Policy: 1-Year Changes in Compliance of Bars and Restaurants in Philadelphia.

PURPOSE: To evaluate changes in compliance with a smoke-free outdoor seating policy before and after passage of a local regulation in 2015, which reinterpreted Philadelphia's Clean Indoor Air Worker Protection Law to include outdoor seating areas of food or beverage establishments. DESIGN: Natural experiment. SETTING: Philadelphia, Pennsylvania. SAMPLE: Food or beverage establishments (N = 108). Establishments were comprised of sit-down restaurants, cafes, quick-service restaurants, and bars. MEASURES: Presence of outdoor smoking and smoking-related litter on a given day were measured as binary variables. A geographic information system-based survey developed for this study was used to collect observational data. ANALYSIS: Logistic regressions were used to determine the change in odds of observing outdoor smoking and smoking-related litter on a given day from baseline (preregulation) to follow-up (postregulation). RESULTS: Compliance with smoke-free outdoor seating increased from 84.5% to 95.4% after passage and implementation of the regulation. Results showed a significant 75% decrease (odds ratio [OR]: = 0.25, 95% confidence interval [CI]: 0.08-0.67) in odds of outdoor smoking and a slight decrease in smoking-related litter (OR: 0.81, 95% CI: 0.39-1.65) at follow-up in establishments overall. However, at baseline, bars had higher odds of outdoor smoking (OR: 2.68, 95% CI: 0.57-12.72) and smoking-related litter (OR: 4.09, 95% CI:, 1.87-9.49) compared to sit-down restaurants. CONCLUSION: Results suggest there is high compliance with low-cost, low-burden, smoke-free outdoor seating policy and that enforcement is best targeted toward bars.