Air pollution and well-being: assessing risks and enhancing education in uganda (aware study) - significance: air pollution is the leading environmental cause of death globally and the greatest threat…

The National Institute of Environmental Health Sciences, a component of the Department of Health and Human Services, awarded The General Hospital Corporation (Massachusetts General Hospital) $376,238 on September 23, 2025, under the Environmental Health program (CFDA 93.113, Program Grant R21ES036753).

The project, titled "Air Pollution and Well-Being: Assessing Risks and Enhancing Education in Uganda (AWARE Study)," characterizes local knowledge, attitudes, and perceptions about air pollution and health among highly exposed populations in Uganda using the Health Belief Model, with findings informing design of a contextually appropriate educational strategy to reduce personal air pollution exposure. The work addresses the gap between World Health Organization guidelines for individual-level behavioral modification to reduce air pollution exposure and the applicability and awareness of these guidelines among populations in resource-limited settings, particularly sub-Saharan Africa.

Performance runs through August 30, 2027, with work performed in Boston, Massachusetts. Principal Investigator Dr. North leads an interdisciplinary team with expertise in air pollution-related cardiopulmonary health and behavioral science.

Ann & Robert H Lurie Children's Hospital of Chicago serves as sub-recipient (sub-award R21ES036753-GR1002998-S01, awarded January 27, 2026). Dr. Sahera Dirajlal-Fargo, Associate Professor at Northwestern University Feinberg School of Medicine and pediatric infectious diseases attending at Lurie Children's, serves as Co-Investigator and Site Principal Investigator. Dr. Dirajlal-Fargo manages IRB approvals and regulatory compliance, conducts data entry and quality control, supports site monitoring, and directs interpretation and reporting of study results. She brings ten years of experience with international research collaborations in Uganda and longitudinal cohorts of children, adolescents, and parents.

Air pollution and well-being: assessing risks and enhancing education in uganda (aware study) - 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.