BackgroundThe Mexico City Metropolitan Area has an expansive urban population and a long history of air quality management challenges. Poor air quality has been associated with adverse pulmonary and cardiac health effects, particularly among susceptible populations with underlying disease. In addition to reducing pollution concentrations, risk communication efforts that inform behavior modification have the potential to reduce public health burdens associated with air pollution.MethodsThis study investigates the utilization of Mexico’s IMECA risk communication index to inform air pollution avoidance behavior among the general population living in the Mexico City Metropolitan Area. Individuals were selected via probability sampling and surveyed by phone about their air quality index knowledge, pollution concerns, and individual behaviors.ResultsThe results indicated reasonably high awareness of the air quality index (53% of respondents), with greater awareness in urban areas, among older and more educated individuals, and for those who received air quality information from a healthcare provider. Additionally, behavior modification was less influenced by index reports as it was by personal perceptions of air quality, and there was no difference in behavior modification among susceptible and non-susceptible groups.ConclusionsTaken together, these results suggest there are opportunities to improve the public health impact of risk communication through an increased focus on susceptible populations and greater encouragement of public action in response to local air quality indices.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5418-5) contains supplementary material, which is available to authorized users.

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Health risks from air pollution continue to be a major concern for residents in Mexico City. These health burdens could be partially alleviated through individual avoidance behavior if accurate information regarding the daily health risks of multiple pollutants became available. A split sample approach was used in this study to create and validate a multi-pollutant, health-based air quality index. Poisson generalized linear models were used to assess the impacts of ambient air pollution (i.e., fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ground-level ozone (O3)) on a total of 610,982 daily emergency department (ED) visits for respiratory disease obtained from 40 facilities in the metropolitan area of Mexico City from 2010 to 2015. Increased risk of respiratory ED visits was observed for interquartile increases in the 4-day average concentrations of PM2.5 (Risk Ratio (RR) 1.03, 95% CI 1.01–1.04), O3 (RR 1.03, 95% CI 1.01–1.05), and to a lesser extent NO2 (RR 1.01, 95% CI 0.99–1.02). An additive, multi-pollutant index was created using coefficients for these three pollutants. Positive associations of index values with daily respiratory ED visits was observed among children (ages 2–17) and adults (ages 18+). The use of previously unavailable daily health records enabled an assessment of short-term ambient air pollution concentrations on respiratory morbidity in Mexico City and the creation of a health-based air quality index, which is now currently in use in Mexico City.

Background The Air Quality Index (AQI) in the United States is widely used to communicate daily air quality information to the public. While use of the AQI has led to reported changes in individual behaviors, such behavior modifications will only mitigate adverse health effects if AQI values are indicative of public health risks. Few studies have assessed the capability of the AQI to accurately predict respiratory morbidity risks. Methods and findings In three major regions of California, Poisson generalized linear models were used to assess seasonal associations between 1,373,165 respiratory emergency department visits and short-term exposure to multiple metrics between 2012–2014, including: daily concentrations of NO2, O3, and PM2.5; the daily reported AQI; and a newly constructed health-based air quality index. AQI values were positively associated (average risk ratio = 1.03, 95% CI 1.02–1.04) during the cooler months of the year (November-February) in all three regions when the AQI was very highly correlated with PM2.5 (R2 ≥ 0.89). During the warm season (March-October) in the San Joaquin Valley region, neither AQI values nor the individual underlying air pollutants were associated with respiratory morbidity. Additionally, AQI values were not positively associated with respiratory morbidity in the Southern California region during the warm season, despite strong associations of the individual underlying air pollutants with respiratory morbidity; in contrast, health-based index values were observed to be significantly associated with respiratory morbidity as part of an applied policy analysis in this region, with a combined risk ratio of 1.02 (95% CI: 1.01–1.03). Conclusions In regions where individual air pollutants are associated with respiratory morbidity, and during seasons with relatively simple air mixtures, the AQI can effectively serve as a risk communication tool for respiratory health risks. However, the predictive ability of the AQI and any other index is contingent upon the monitored values being representative of actual population exposures. Other approaches, such as health-based indices, may be needed in order to effectively communicate health risks of air pollution in regions and seasons with more complex air mixtures.

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