How do Montreals heart and lung patients cope with smog

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How do Montreals heart and lung patients
cope with smog

• Tom Kosatsky1, Lucie Richard2 , Annie Renouf1,
• Julie Dufresne1, Dave Stieb3, Nadia Giannetti4
  ,Jean Bourbeau5
• Montreal Public Health1, Faculty of Nursing,
  University of Montreal2, Air Pollution Effects
  Division, Health Canada3, Heart Failure and Heart
  Transplant Centre, Royal Victoria Hospital4, COPD
  Clinic and Pulmonary Rehabilitation Programme,
  Montreal Thoracic Institute5
• Funded by Climate Change Action Funds Contract,
  NR Canada A-575

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Rationale for our study

• Persons with COPD and CHF are particularly
  vulnerable to air pollution
• Smog warnings target these groups
• We know little of the their awareness of poor air
  quality and of their conduct towards it
• (both generally, and specifically during poor
  AQ days)

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Project overview
Inception questionnaire (n 242) Q1
Dimensions Attitudes, knowledge and behaviours
related to heat and smog Method Face to face,
either at the clinic or at home Duration (30-110
min) mean  54 min Administered May 30 to Oct.
6, 2005
Post-season questionnaire (n 112)
Post-event questionnaire (n 100) Q2
Dimensions Knowledge and behaviour during an
extreme heat warning and/or smog warning Method
Phone interview Duration (7-60 min) mean  11
min Administered June 14 to Sept. 15, 2005
June
July
August
Sept.
Oct.
Nov.
2005
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Research questions

• Awareness and perception of air pollution
• Representations of smog
• Perception of vulnerability
• Symptoms reported during poor AQ days
• Awareness of poor AQ days
• Smog warning awareness
• Protective behaviours adopted during smog events

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Whom we interviewed, when, how

• Who
• Of 100 post-event respondents, 56 were
  interviewed the day after an EC air quality
  warning, of whom 14 had originally been recruited
  from cardiac and 42 from pulmonary centres
• When and How
• A minimum of five days after the face-to-face
  inception questionnaire
• Telephoned the day following a smog warning, or a
  combined heat and smog warning
• Questions relate to the preceding 24 hours
• We also analysed relevant inception questionnaire
  responses

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Temperature, particulate and ozone levels during
the 5 EC warning episodes studied (2005)
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Profile of post-event respondents
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Participants level of function
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We assessed (at post-event phone interview)

• Smog perception / warning awareness
• Would you say the air was polluted yesterday?
  (yes/no)
• What makes you say the air was polluted? (open)
• During the past 24 hours, have you heard tell of
  a smog warning? (yes/no)
• Where did you hear about the smog warning?
  (yes/no for each information source proposed)
• Protective behaviours adopted I will read a
  list of things you might have done because of
  outdoor conditions. During the last 24 hours, did
  you?
• (yes/no for each action proposed)
• 
  

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Symptoms reported during EC air quality alerts
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Smog perception and smog warning awareness
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Representations of smog (Q1)
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Perception of vulnerability

• In general (Q1)
• True or false People with cardiac or respiratory
  problems are hospitalized more often when the
  level of air pollution is high.
• True 56 (100)
• Has your doctor or nurse ever told you that
  health problems could make you more sensitive to
  air pollution?
• Yes 29 (52)
• During the smog event (Q2)
• During the past 24 hours, did air pollution
  affect your health?
• Not at all (54), slightly (25), moderately
  (13),
• quite a bit (5), extremely (4)
• During the past 24 hours, did air pollution
  prevent you from continuing your daily
  activities?
• Not at all (43), slightly (27), moderately
  (14),
• quite a bit (14), extremely (2)

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Protective behaviours adopted during smog events
(Q2)
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What I did yesterday (Q2), versuswhat advisories
tell us to do (Q1)
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To recapitulate about our participants

• Apart from their age and chronic disease
• 42 have income below Statcans low income
  threshold
• Almost half live alone
• 45 receive a visitor no more than once a month
• COPD patients are particularly limited in their
  physical functioning

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To recapitulate knowledge, awareness, attitudes

• Incomplete, and sometimes confused notion of
  smog
• Only 32 include air pollution
• 25 mention weather conditions suggesting
  confusion with hot weather
• 77 heard the smog warning (mostly on TV), and
  70 considered the air polluted, principally
  through their senses or because of symptoms they
  attribute to smog
• All are aware that their illness makes them
  vulnerable to smog
• Half have been informed by their doctor/nurse

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To recapitulate their conduct on smoggy days

• During a smoggy day, almost half the sample say
  smog has a negative effect on their health
• Most common symptom is difficulty breathing
• During a smoggy day, a majority say they reduce
  their physical activity (75), and inform someone
  about their current state (79)
• Few, however, (25) report asking for or being
  offered help on smoggy days, while 57 say that
  smog prevents them from carrying out daily
  activities

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Limits and Strengths

• Limits
• Difficulty of studying a purely smog event
• Response priming
• Social desirability of certain responses
• Strengths
• Vulnerable population
• Interviewed during a smog event
• Part of an ongoing study responses can be
  compared to what I usually do