How do Montreal’s heart and lung patients cope with smog

1. How do Montreal’s 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

2. 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)

3. Dimensions: Knowledge and perceptions regarding heat/smog and safety measures Method: Phone interview Duration: (8-37 min) mean : 19 min Administered: Oct. 11 to Nov. 24, 2005 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

4. 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

5. 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

6. Temperature, particulate and ozone levels during the 5 EC warning episodes studied (2005)

7. Profile of post-event respondents

8. Participants’ level of function

9. 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)

10. Symptoms reported during EC air quality alerts

11. Smog perception and smog warning awareness

12. Representations of “smog” (Q1)

13. 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%)

14. Protective behaviours adopted during smog events (Q2)

15. What I did yesterday (Q2), versuswhat advisories tell us to do (Q1)

16. To recapitulate: about our participants Apart from their age and chronic disease: • 42% have income below Statcan’s 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

17. 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

18. 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

19. 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”