Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health.

BACKGROUND: Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its 'invisible' nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals. OBJECTIVE: This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health. METHODS: Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study. RESULTS: All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (-23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (-15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group's asthma-related quality of life improved compared to the control group. IMPACT STATEMENT: This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants' home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health.

"I have to stay inside ": Experiences of air pollution for people with asthma.

Asthma, characterized by airway inflammation, sensitization and constriction, and leading to symptoms including cough and dyspnoea, affects millions of people globally. Air pollution is a known asthma trigger, yet how it is experienced is understudied and how individuals with asthma interact with air quality information and manage exacerbation risks is unclear. This study aimed to explore how people living with asthma in Scotland, UK, experienced and managed their asthma in relation to air pollution. We explored these issues with 36 participants using semi-structured interviews. We found that self-protection measures were influenced by place and sense of control (with the home being a "safe space"), and that the perception of clean(er) air had a liberating effect on outdoor activities. We discuss how these insights could shape air quality-related health advice in future.

Personal exposure to fine particulate matter (PM2.5) and self-reported asthma-related health.

PM2.5 (fine particulate matter ≤2.5 µm in diameter) is a key pollutant that can produce acute asthma exacerbations and longer-term deterioration of respiratory health. Individual exposure to PM2.5 is unique and varies across microenvironments. Low-cost sensors (LCS) can collect data at a spatiotemporal resolution previously unattainable, allowing the study of exposures across microenvironments. The aim of this study is to investigate the acute effects of personal exposure to PM2.5 on self-reported asthma-related health. Twenty-eight non-smoking adults with asthma living in Scotland collected PM2.5 personal exposure data using LCS. Measurements were made at a 2-min time resolution for a period of 7 days as participants conducted their typical daily routines. Concurrently, participants were asked to keep a detailed time-activity diary, logging their activities and microenvironments, along with hourly information on their respiratory health and medication use. Health outcomes were modelled as a function of hourly PM2.5 concentration (plus 1- and 2-h lag) using generalized mixed-effects models adjusted for temperature and relative humidity. Personal exposures to PM2.5 varied across microenvironments, with the largest average microenvironmental exposure observed in private residences (11.5 ± 48.6 µg/m3) and lowest in the work microenvironment (2.9 ± 11.3 µg/m3). The most frequently reported asthma symptoms, wheezing, chest tightness and cough, were reported on 3.4%, 1.6% and 1.6% of participant-hours, respectively. The odds of reporting asthma symptoms increased per interquartile range (IQR) in PM2.5 exposure (odds ratio (OR) 1.29, 95% CI 1.07-1.54) for same-hour exposure. Despite this, no association was observed between reliever inhaler use (non-routine, non-exercise related) and PM2.5 exposure (OR 1.02, 95% CI 0.71-1.48). Current air quality monitoring practices are inadequate to detect acute asthma symptom prevalence resulting from PM2.5 exposure; to detect these requires high-resolution air quality data and health information collected in situ. Personal exposure monitoring could have significant implications for asthma self-management and clinical practice.

From reflection diaries to practical guidance for transdisciplinary research: learnings from a Kenyan air pollution project.

Transdisciplinary research (TDR) approaches have been cited as essential for overcoming the intractable sustainability challenges that the world is currently facing, including air pollution, water management and climate change. However, such approaches can be difficult to undertake in practice and can consequently fail to add value. Therefore, examples of what works in practice (and what does not) are helpful to guide future research. In this study, we used a conceptual TDR framework as the basis to examine and evaluate the strengths and weaknesses of our approach in a project exploring air pollution in an informal settlement in Nairobi, Kenya. Reflection diaries exploring experiences of participation in the project were undertaken by the project team (comprising academic and community partners) at multiple time points throughout the project. These reflection diaries played an important role in evaluation and for providing space for team learning. Diaries were thematically coded according to the TDR framework to explore aspects of the project that worked well, and areas which presented challenges. We draw upon our reflections, and the extant literature, to make practical recommendations for researchers undertaking TDR projects in future. Recommendations focus on three key project stages (pre-funding, funded period, post-funding) and include; building the team in a way that includes all key stakeholders in relevant and appropriate roles, giving everyone sufficient time to work on the project, and ensuring regular and open communication. Building these recommendations into the design and delivery of transdisciplinary sustainability science projects will support progress towards achieving the Sustainable Development Goals (SDGs). Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-023-01317-0.

Public engagement with air quality data: using health behaviour change theory to support exposure-minimising behaviours.

Exposure to air pollution prematurely kills 7 million people globally every year. Policy measures designed to reduce emissions of pollutants, improve ambient air and consequently reduce health impacts, can be effective, but are generally slow to generate change. Individual actions can therefore supplement policy measures and more immediately reduce people's exposure to air pollution. Air quality indices (AQI) are used globally (though not universally) to translate complex air quality data into a single unitless metric, which can be paired with advice to encourage behaviour change. Here we explore, with reference to health behaviour theories, why these are frequently insufficient to instigate individual change. We examine the health behaviour theoretical steps linking air quality data with reduced air pollution exposure and (consequently) improved public health, arguing that a combination of more 'personalised' air quality data and greater public engagement with these data will together better support individual action. Based on this, we present a novel framework, which, when used to shape air quality interventions, has the potential to yield more effective and sustainable interventions to reduce individual exposures and thus reduce the global public health burden of air pollution.

Daily changes in household water access and quality in urban slums undermine global safe water monitoring programmes.

Global drinking water monitoring programmes and studies on water quality in urban slums often overlook short-term temporal changes in water quality and health risks. The aim of this study was to quantify daily changes in household water access and quality in an urban slum in Malawi using a mixed-method approach. Household drinking water samples (n = 371) were collected and monitored for E. coli in tandem with a water access questionnaire (n = 481). E. coli concentrations in household drinking water changed daily, and no household had drinking water that was completely safe to drink every day. Seasonal changes in drinking water availability, intermittent supply, limited opening hours, and frequent breakdown of public water points contributed to poor access. Households relied on multiple water sources and regularly switched between sources to meet daily water needs. There were generally similar E. coli levels in water samples considered safe and unsafe by residents. This study provides the first empirical evidence that water quality, water access, and related health risks in urban slums change at much finer (daily) temporal scales than is conventionally monitored and reported globally. Our findings underscore that to advance progress towards Sustainable Development Goal (SDG) Target 6.1, it is necessary for global water monitoring initiatives to consider short-term changes in access and quality.

Resolution of the mediators of in vitro oxidative reactivity in size-segregated fractions that may be masked in the urban PM(10) cocktail.

PM10 (particulate matter 10 µm or less in aerodynamic diameter) has consistently been linked with adverse human health effects, but the physicochemical properties responsible for this effect have not been fully elucidated. The aim of this work was to investigate the potential for carbon black (CB) particles and PM to generate ROS (Reactive Oxygen Species) and to identify the physicochemical properties of the particles responsible for in vitro oxidative reactivity (OR). PM10 was collected in 11 size fractions at a traffic site in Swansea, UK, using an Electrical Low Pressure Impactor (ELPI). The PM physicochemical properties (including size, morphology, type, and transition metals) were tested. The plasmid scission assay (PSA) was used for OR testing of all particles. The ultrafine and fine PM fractions (N28-2399; 28-2399 nm) caused more DNA damage than coarse PM (N2400-10,000), and the increased capacity of the smaller particles to exhibit enhanced (OR) was statistically significant (p<0.05). The most bioreactive fraction of PM was N94-155 with a toxic dose (TD50; mass dose capable of generating 50% plasmid DNA damage) of 69 µg/ml. The mean TD35 was lower for PM than CB particles, indicating enhanced OR for PM. A difference between CB and PM in this study was the higher transition metal content of PM. Zn was the most abundant transition metal (by weight) in the ultrafine-fine PM fractions, and Fe in the fine-coarse PM. Through this comparison, part of the observed increased PM OR was attributed to Zn (and Fe). In this study PM-derived DNA damage was dependent upon; 1) particle size, 2) surface area, and 2) transition metals. This study supports the view that ROS formation by PM10 is related to physicochemistry using evidence with an increased particle size resolution.