People, place and pollution: Investigating relationships between air quality perceptions, health concerns, exposure, and individual- and area-level characteristics.

An extensive body of research has demonstrated that air pollution exposure is associated with adverse health outcomes. Urban air quality remains a major concern for both public health officials and the general public. In the United States, air quality public awareness campaigns are major efforts of governments at every level. Yet, our understanding of relationships between ambient air pollution exposure, public perceptions of air quality, and concerns about associated health risks is incomplete. We examined 2869 individual responses to annual air quality public awareness surveys administered between 2009 and 2012 in the Kansas City metropolitan area. Our study had three objectives: 1) examine the spatial distribution of PM2.5 and O3 exposures, pollution perceptions, and pollution health concerns; 2) explore relationships between individual- and area-level characteristics and PM2.5 and O3 exposure; 3) and examine cross-sectional associations between individual- and area-level characteristics, as well as PM2.5 and O3 exposures, and pollution perception and pollution health concerns. We found inverse spatial patterns between the distribution of O3 and PM2.5 exposure levels as well as between areas where respondents perceived air pollution as worsening and areas where residents had higher concern about the health effects of pollution exposure. We also found inverse relationships between individual- and area-level demographic and socioeconomic characteristics and O3 and PM2.5 exposure. Individual-level characteristics were significantly related to pollution perceptions, while both individual- and area-level characteristics were significantly related to pollution health concerns. Public awareness campaigns should be combined with education on ways the public can protect themselves and tailored explicitly for targeting vulnerable populations (e.g., elderly, and persons with respiratory problems) and areas both socioeconomically vulnerable (e.g., higher racial segregation and poverty) and experiencing higher pollution exposure (e.g., O3 and PM2.5).