The role of perceived air pollution and health risk perception in health symptoms and disease: a population-based study combined with modelled levels of PM10

Adverse health impact of air pollution on health may not only be associated with the level of exposure, but rather mediated by perception of the pollution and by top-down processing (e.g. beliefs of the exposure being hazardous), especially in areas with relatively low levels of pollutants. The aim of this study was to test a model that describes interrelations between air pollution (particles < 10 m, PM10), perceived pollution, health risk perception, health symptoms and diseases. A population-based questionnaire study was conducted among 1000 Estonian residents (sample was stratified by age, sex, and geographical location) about health risk perception and coping. The PM10 levels were modelled in 1 x 1 km grids using a Eulerian air quality dispersion model. Respondents were ascribed their annual mean PM10 exposure according to their home address. Path analysis was performed to test the validity of the model. The data refute the model proposing that exposure level significantly influences symptoms and disease. Instead, the perceived exposure influences symptoms and the effect of perceived exposure on disease is mediated by health risk perception. This relationship is more pronounced in large cities compared to smaller towns or rural areas. Perceived pollution and health risk perception, in particular in large cities, play important roles in understanding and predicting environmentally induced symptoms and diseases at relatively low levels of air pollution.