A national survey of ambient air pollution health literacy among adult residents of Taiwan

Hou et al. BMC Public Health (2021) 21:1604 https://doi.org/10.1186/s12889-021-11658-z RESEARCH Open Access A national survey of ambient air pollution health literacy among adult residents of Taiwan Wen-Hsuan Hou1,2,3, Yi-Chin Huang4, Chien-Yeh Lu4, I-Chen Chen4,5, Pei-Chen Lee6, Ming-Yeng Lin7, Yu-Chen Wang8, Lilis Sulistyorini9 and Chung-Yi Li4,9,10,11* Abstract Objective: To investigate the level of and covariates associated with ambient air pollution health literacy (AAPHL) among adult residents of Taiwan. Methods: With a cross-sectional study design, we conducted telephone interviews using a Chinese version AAPHL scale, which consisted of 24 items assessing 12 subdomains of AAPHL formed by 4 information processing competence matrices (i.e., access, understand, appraise, and apply) and 3 health contexts (i.e., healthcare, disease prevention, and health promotion). The AAPHL was with the lowest and highest score at 1 to 4, respectively. Between September and November 2020, a sample of 1017 and 280 adults was successfully interviewed via home phones and mobile phones, respectively. We employed multiple linear regression models to identify covariates significantly associated with overall and 4 matric-specific AAPHL scores. Results: The mean and standard deviation (±SD) of overall AAPHL score was considered as moderate at 2.90 (±0.56), with the highest and lowest metric-specific score for “apply” (3.07 ± 0.59) and “appraise” (2.75 ± 0.66). Lower education was significantly associated with a lower overall score; and living with children < 12 years and single were both significantly associated with higher overall scores. We also noted a significant geographic variation in overall score in which people living in the east/remote islands had highest scores. Conclusions: People in Taiwan had only moderate level of AAPHL; and covariates including education, living arrangement, marital status, and area of living were significantly associated with AAPHL. These covariates should be considered in future educational interventions aiming to improve the AAPHL in the community. Keywords: Ambient air pollution, environmental health literacy, Cross-sectional studies, Community health, Linear regression model * Correspondence: 4 Department of Public Health, College of Medicine, National Cheng Kung University, #1, University Rd, Tainan, Taiwan 701 9 Department of Environmental Health, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Hou et al. BMC Public Health (2021) 21:1604 Introduction Ambient air pollution is a major environmental health problem affecting everyone in low-, middle-, and highincome countries; and representing a considerable threat to health worldwide [1]. According to the definition form WHO, ambient air pollution is a broader term used to describe air pollution in outdoor environments, while urban outdoor air pollution is a more specific term referring to the ambient air pollution experienced by populations living in urban areas, typically in or around cities [1, 2]. According to the 2015 Global Burden of Disease Study [3], exposure to ambient fine particulate matter PM2.5 is the fifth leading cause of death worldwide, accounting for 4.2 million deaths and 103.1 million disability-adjusted life-years in 2015 globally. Epidemiological studies reported links between air pollution and certain diseases of public health importance such as cardiovascular diseases, cancers, and respiratory diseases [4]. Recent studies also revealed potential influence of air pollution on psychiatric disorders [5, 6]. Taiwan is no exception [7]. Estimated in 2014, PM2.5 accounted for 6,282 deaths from ischemic heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease, representing a population attributable mortality fraction of 18.6% associated with the four disease causes [7]. Ambient air pollution is a function of complex systems, and solutions to the problem also require multilevel intervention [8]; and education of people involved in the air pollution control strategies, including scientists, negotiators, decision makers and the public, to raise the environmental awareness is essential for reducing the air pollution [9]. Previous studies have demonstrated that environmental health education interventions at formal education or in the community could significantly have knowledge gains related to environmental health, individual behavior changes, and collective action for community change [10, 11]. Effective educational interventions were found to increase prevalence and effects of so-called avoidance behaviors in lowering the adverse effects of air pollution on health [12]. Such activities include purchasing preventive pharmaceuticals and reducing time spent in polluted environments [13]. The knowledge of environmental health and the behavior of environmental protection, which is so called environmental health literacy (EHL), with a root of both health literacy [14] and risk communication [10, 11], is an emerging area of study that incorporates content and strategies from environmental, health, and social sciences to promote understanding of the ways environmental contaminants affect health [15], which can be used as a tool for evaluating the effectiveness of environmental education. The earlier conceptual model of EHL was adapted from Bloom (1956), representing the Page 2 of 11 stepwise progression of six distinct educational stages (i.e, create, evaluate, analyze, apply, understand, and recognize) to approach the development of targeted interventions for different levels of EHL [16]. The EHL on ambient air pollution can be enhanced by empowering individuals and communities to use appropriate communication for controlling air pollution exposures. However, to the best of our knowledge, previous air poll (...truncated)