Air Pollution and Well-Being: Assessing Risks and Enhancing Education in Uganda (AWARE Study)

About This Grant

Significance: Air pollution is the leading environmental cause of death globally and the greatest threat to human health. Ambient and household air pollution are responsible for an estimated 7 million deaths and 192 million years of life lost each year, driven primarily by cardiovascular and respiratory disease, and disproportionately affect children and older adults. Substantial global differences in air pollution exposure lead to higher exposures among some populations, so reducing exposure among these populations is crucial to reduce global mortality. Parallel to global efforts focused on improving country-level air quality through multinational collaborations – which will take decades to reduce individual-level air pollution exposure – the WHO established guidelines for reducing personal air pollution exposure focused on individual-level behavioral modifications. However, to what extent the WHO guidelines are applicable to and known by populations living in resource-limited settings, and specifically sub-Saharan Africa, is unknown. Individual-level motivation to modify behavior to avoid pollution exposure are based upon individuals’ awareness about air pollution, their willingness to act, their ability to change, and competing priorities. Innovation: Herein, using the Health Belief Model, we apply a behavioral health-focused approach to characterize local knowledge, attitudes, and perceptions about air pollution and health among highly exposed populations in Uganda, which will inform the design of a contextually appropriate educational strategy to reduce personal air pollution exposure. Investigators: Our interdisciplinary team, with expertise in air pollution-related cardiopulmonary health (Principal Investigator North, an early career investigator fitting the NIH’s “Next Generation Researcher” goals; co-Investigator Dirajlal-Fargo), behavioral science and qualitative methodology (Ashaba, Psaros), air pollution exposure (Onyango), and observational cohort enrollment and retention (Musiime), will conduct the aims of this grant. Approach: We will leverage the research infrastructure of the CAD-Lung (K23HL154863, PI: North) and TIMING (U01AI168630; PI: Dirajlal-Fargo) studies, which are ongoing observational cohort studies in rural and urban Uganda, respectively. CAD-Lung, based in Mbarara, follows adults at least 40 years of age and TIMING, based in Kampala, follows children and adolescents. We will conduct focus group disussions among a subset of participants in the CAD-Lung and TIMING studies to [Aim 1] explore knowledge, attitudes, and perceptions of air pollution and health, and [Aim 2] design and assess preliminary acceptability/feasibility of a multifaceted strategy (termed the AWARE Toolkit) focused on encouraging behavior change to reduce personal exposure to air pollution. Findings from this study will provide the requisite preliminary data to inform the design of our future R01 hybrid implementation-effectiveness RCT to evaluate the impact, implementation, and cost effectiveness of the AWARE Toolkit among highly exposed populations in East Africa.