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A study of parents' perception of air pollution and its effect on their children's respiratory health in Nanchang, China.(INTERNATIONAL PERSPECTIVES)(Survey)
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Abstract:

This cross-sectional survey was conducted to understand parents' perceptions regarding air pollution and its effect on children's respiratory health in Nanchang, China, to offer baseline information useful to the government of the People's Republic of China. Data collected from 1,056 residents (response rate = 93.7%) was analyzed using descriptive analysis, chi-square test, nonparametric rank-sum test, Spearman rank correlation coefficient, and linear trend test. The results showed that most parents would worry more about their children's health if air quality became worse, especially in families with high education and income. The top three respiratory conditions associated with poor air quality among children were cough (90.5%), upper respiratory infection (72.9%), and bronchitis (47.2%). Parents believed motor vehicle emissions (95.9%), secondhand smoke (95.4%), and dust (92.9%) to be the risk factors largely responsible for respiratory illnesses among children. Furthermore, most respondents supported government intervention to improve air quality with several suggestions: controlling industrial pollution (69.9%), increasing public transportation and reducing private cars (51.0%), and controlling and reducing waste incineration (45.6%).

Introduction

People in China are becoming more aware of the quality of their life, opting to live in a comfortable environment and to lead a healthy lifestyle. This shift is due to the rapidly developing economy, progress of science and technology, and the improvement of people's living standards (Zhang, Yuan, & Zhao, 2011). The rapid urbanization and population density surge in parts of China, however, have released large amounts of harmful pollutants into the atmosphere, seriously threatening people's health. Particulate matter less than 10 micrometers in diameter ([PM.sub.10]), sulfur dioxide (S[O.sub.2]), and nitrogen oxides (N[O.sub.x]) are the main air pollutants caused by the manufacturing industry and transportation. Emission of S[O.sub.2] is primarily from industry and daily activities such as coal burning by residents (Ministry of Environmental Protection of the People's Republic of China [MEP], 2013). Coal burning has been reduced to 20.4 million tons, a 3.5% reduction compared with 2012. In China in 2013, N[O.sub.x] emissions, which are released primarily by industrial and motor vehicle exhaust, were reduced to 22.3 million tons, representing a 4.7% reduction compared with 2012 (MEP, 2013).

These improvements notwithstanding, the city's ambient air quality status is still not cause to be optimistic. Air quality remains a health risk in most of the major cities (World Health Organization [WHO], 2016). According to the Ministry of Environmental Protection of the People's Republic of China (MEP), a surveillance study was conducted in 2013 among 74 cities in China, including Beijing, Tianjin, and cities along the Yangtze River and Pearl River regions. MEP assessed the effects of the implementation of new ambient air quality standards with modified indication values of S[O.sub.2], N[O.sub.2], [PM.sub.10], [PM.sub.2,5], carbon monoxide (CO), and ozone ([O.sub.3]) (MEP, 2012). MEP reported that only three cities--Haikou, Zhoushan, and Lhasa--met the air quality standards, accounting for 4.1% of cities assessed, while the other 71 cities (95.9%) were above recommended pollutant levels (MEP, 2013).

Nanchang, the capital of Jiangxi province and the 25th largest city in China, is adjacent to the three most dynamic economic developmental regions: the Yangtze River delta, the Pearl River delta, and MinDongNan triangle. Nanchang's economy relies mainly on industry, particularly construction, making it subject to air pollution with particulate matter and other pollutants (National Bureau of Statistics of the People's Republic of China, 2014).

One study found that the higher concentration of [PM.sub.10] was largely due to city construction dust and vehicle exhaust emission, which was a result of increased motor vehicles and more construction sites for city buildings, as well as subway development in the past years (Zou et al., 2015). In Nanchang, 7 of 40 days (<18%) measured between April and May 2014 did not meet the ambient air quality standards (Nanchang City Environmental Protection Bureau, 2014).

Air quality is closely related to the overall competitiveness of a city, directly affecting residents' health and quality of life, which impacts the investment environment. The World Health Organization (WHO) reported that outdoor air pollution in both urban and rural areas caused approximately 3.7 million premature deaths worldwide in 2012; furthermore, 88% of deaths occurred in low-and middle-income level countries, primarily located in the western Pacific and Southeast Asia (WHO, 2016).

Indoor air pollution is a problem, too. Approximately 4.3 million people die each year from indoor air pollution from causes such as inefficient cooking and heating practices (cooking and heating their homes with solid fuels such as wood, charcoal, coal, dung, crop wastes) and smoking in and around the home (WHO, 2014).

Other reports have indicated air pollution is associated with a broad range of health risks (Collins, Parsons, & Zinyemba, 2014) and might potentially play a role in elevated incidence rates of breast cancer in urban areas (Garcia et al., 2014). This issue has attracted close attention from the government and residents of the People's Republic of China.

The serious effects of poor air quality on the sensitive respiratory systems of children are much more apparent than in adults. A study by Liu and Zhang (2009) found major effects of air pollution on children's lung function. The levels of total suspended particles and S[O.sub.2] in ambient air correlated with damage to the big airway function of children, while N[O.sub.x] mainly affected the small airway function. Another study revealed a positive correlation of the exposure to [PM.sub.2.5] and [PM.sub.10] with the incidence of childhood respiratory illnesses (Liu, Li, Hu & Sun, 2014). Studies on the effects of air pollution on respiratory health have frequently been conducted in many parts of the world (Beatty & Shimshack, 2014; Kong, He, Xu, Xu, & Guo, 2001).

Additionally, there have been several studies on air quality including environmental air quality standards and management policies, the air pollution index variation characteristics and influence factors, and the effects of air quality on health (Liao, Xu, & Zhang, 2010; Liu et al., 2005; Wang et al., 2013).

Little investigation, however, has been conducted to examine the public's perceptions regarding air pollution and its effect on children's respiratory health in China. This study, through interviews with Nanchang parents of both healthy and sick children, aimed to understand parents' perceptions of Nanchang air quality and the potential effects of air pollution on their children's respiratory health. In addition, this study was designed to obtain baseline information useful to the Nanchang government in its attempt to improve air quality and protect children's respiratory health in the future.

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Materials and Methods

Participants selected for this study were parents, including caregivers and caretakers, who had at least one child between the ages of 2-10 years. Parents were interviewed through a face-to-face method with trained interviewers. A total of 1,056 survey questionnaires were collected. Among these participants, 526 were parents with healthy children from a Nanchang city kindergarten, a primary school of Nanchang, and the Nanchang Center for Disease Control and Prevention (NCDC). The other 530 participants were parents who had sick children waiting to see medical doctors in Jiangxi Children's Hospital in Nanchang. The number of valid responses was 989 (response rate = 93.7%) and the basic demographic information about these respondents is summarized in Table 1.

To ensure the reliability and validity of this survey, the questionnaires used were de signed by public health experts and refined based on our 2013 study (Zhang et al., 2014). Our 2013 study was carried out in four sites, including two NCDC locations, Jiangxi Children's Hospital, and a local kindergarten. Additionally, the study team members received training on questionnaire details and survey techniques. Pilot presurvey tests were performed before the survey was conducted.

The questionnaires covered five major aspects: 1) general demographic characteristics of the interviewees (age, gender, educational level, place of residence, travel experiences, and annual household income); 2) children's health conditions (age, overall health, respiratory diseases, symptoms in children when air quality was poor); 3) parents' concerns about the air quality in Nanchang; 4) parents' understanding of the linkage between air quality and children's health problems (impact on children's respiratory system, factors aggravating symptoms in children, how worried parents were about respiratory health problems caused by air pollution); and 5) parents' attitudes towards the government's policies. All participants were assessed through confidential face-to-face interviews.

All data were analyzed with SPSS version 17.0. General demographic characteristics of the interviewees and health condition of the children were described with descriptive statistics. Chi-square tests compared the differences of parents' perception of air quality and the cognitive relationship of air quality with parents' perception about children's health according to general demographic characteristics of the interviewees. The general chisquare analysis was run on frequency distribution data. A nonparametric rank-sum test was used to order classification data values status. Linear trend tests and Spearman rank correlation coefficients were used to analyze the bidirectional orderly and different properties contingency table data. The level of a was set at 0.05.

Results

Health conditions of healthy children from a Nanchang city kindergarten, a primary school of Nanchang, and NCDC locations were much better than sick children from Jiangxi Children's Hospital (p < .001), matching assumptions that children selected from the kindergarten would be much healthier than those from the hospital site. Most participants generally believed that their child's overall health was good (69.2%) (Table 2). Data indicated that parents' perception of their children's health was significantly affected by location of their residence, showing that parents from Nanchang city considered their children to be healthier than those from the countryside (p = .004). Parents' age was shown to be a significant factor affecting their perception of children's health. Older parents had higher rates of believing their children to be in good health (p < .001). Our data showed that travel experience nationally and/or internationally was also a significant factor affecting parents' perception of their children's health (Table 2).

Based on parent recall, cough, upper respiratory tract infection, and bronchitis were the top three common respiratory conditions among children in Nanchang (Table 3). The rates of coughing in children significantly increased, 90.5% versus 82.8%, when compared with 2013 ([chi square] = 113.786, p < .001). Although 72.9% of children suffered from upper respiratory tract infection, a decrease is shown when compared with the 2013 study result of 89.5% ([chi square] = 138.106, p < .001). The frequency of bronchitis, however, was 47.2%, which was significantly greater than the results of our 2013 study of 29.3% ([chi square] = 98.889, p < .001) (Zhang et al., 2014). The data in Table 4 show the Spearman rank correlation coefficient ([r.sub.s]) between perceptions and respiratory diseases in children; that is, parents' perception about the general health condition of their child was in accordance with rates of allergies ([r.sub.s] = 0.095, p = .003), bronchitis ([r.sub.s] = 0.173, p < .001), upper respiratory infection ([r.sub.s] = 0.218, p < .001), and coughing ([r.sub.s] = 0.204, p < .001) (Table 4).

As shown in Table 5, the data revealed a positive correlation between concerns regarding children's health and parents' education level, place of residence, annual household income, and travel experience. Parents with a higher educational level (a college degree or higher) and/or higher annual income ([greater than or equal to] 75,000 Chinese yuan) worried more about their children's health ([r.sub.s] = 0.182, p < .001), ([r.sub.s] = 0.123, p < .001), respectively. Parents who live in the city or have previous travel experience were also more likely to be more concerned about their children's health (Table 5).

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When air quality was poor, the top three common symptoms reported by parents with affected children included dry throat pain (60.1%), sneezing (49.5%), and coughing (37.7%) (Figure 1). As shown in Figure 2, the majority of parents believed that their children's respiratory health was affected by polluted air, mainly from motor vehicle emissions (95.9%), secondhand smoking (95.4%), and dust (92.9%). As indicated in Table 6, bronchitis was associated with high levels of dust, vehicle exhaust emissions, and secondhand smoking, which were some of the factors parents considered as worsening their children's respiratory symptoms. While upper respiratory tract infections were associated with dust and motor vehicle exhaust emissions, coughs were associated only with dust.

In view of the current air quality in Nanchang and parents' perceived impact of air quality on children's health, most parents expressed their strong support to local government to improve air quality. Participants were also asked to give their suggestions on measures to improve air quality. The top three suggestions were to control and reduce air pollution from industrial facilities (69.9%), increase public transportation and reduce private cars (51.0%), and control and reduce waste incineration (45.6%). Other suggestions for local governments to consider included reducing cigarette smoke (30.3%), implementing a nationwide effort to control air pollution (29.7%), increasing solar and green energy options (25.9%), and improving urban housing construction (25.6%).

Discussion

With the rapid growth of the Chinese economy, many cities in China are facing a concerning situation of multiple pollutant emissions and poor air quality. Due to elevated energy consumption, electricity generation, and motor vehicle use, increased pollutants are severely and adversely affecting the quality of life of residents (Wang & Hao, 2012). Recent studies on air quality and pollution types have indicated that the pollution in the atmosphere in Nanchang is complex, with several main pollutants including [PM.sub.10], S[O.sub.2], and N[O.sub.x] attributed to motor vehicle exhaust emissions (Zhuang et al., 2014).

The air pollution issue has caught the attention of local government and residents. Risk perception means individuals' feeling and understanding of different objective risk outside (Slovic, 1987). Humans perceive and act on risk in two fundamental ways. Risk as feelings refers to individuals' instinctive and intuitive reactions to danger. Risk as analysis brings logic, reason, and scientific deliberation to bear on risk management (Slovic & Peters, 2006). The public's perception of risk guides their behavior to a large degree, impacting effectiveness of the risk management policy and implementation. Air pollution risk management has become one of the key tasks for the government. Residents' understanding and cooperation (i.e., risk perception) benefit risk management of air pollution (Zhu & Xu, 2014).

Studies on the public's air risk perception started in the 1950s and 1960s in the U.S. with quantitative methods (Johnson et al., 1972; Smith, Schueneman, & Zeidberg, 1964); then in the 1990s, researchers started using qualitative methods on air pollutionrelated perceptions (Saksena, 2011). More re cent studies on air pollution perception have focused on improvement of risk communication (Egondi et al., 2013; Nikolopoulou, Kleissl, Linden, & Lykoudis, 2011) and on factors that can influence perceptions (Johnson, 2012). Part of the aim of these studies was to bridge the gap between scientific research and public awareness.

Our study showed that, as expected, the general health status of children from the Nanchang city kindergarten, the Nanchang primary school, and NCDC sites was better than the health status of children enrolled from Jiangxi Children's Hospital. Researchers expected that children selected from the kindergarten would be much healthier than those from the hospital site. Almost all parents believed that their children's overall health was good, especially those parents living in the city (p = .004). The health status of children in rural areas of Nanchang was reported to be worse than children in the city because rural children were more likely to be subjected to several risk factors, including direct or indirect contact with dust, infectious bacteria, and disease-carrying insects (Pluhar, Piko, Kovacs, & Uzzoli, 2009).

Among the respondents, older parents considered their children to be in better health, with a linear trend value of 22.253 (p < .001). One explanation for this observation is that older parents have greater access to child care, which has been shown keep children healthier. As stated previously, we uncovered a positive correlation between children's health status and parents' travel experience. As travel experience is closely related to household income status, parents with higher income have more means to travel. Those with more resources might also be able to focus more on leading a healthier lifestyle. Our results suggest that families' socioeconomic status has much to do with health status. Thus, findings from this study suggest that education and healthy habits should be promoted, especially in the rural areas, specifically targeting parents ages 20-40 (Neidell, 2004).

The top three respiratory conditions found in children in Nanchang, China, were cough, upper respiratory tract infection, and bronchitis. Cough and bronchitis were particularly prevalent, reaching 90.5% and 47.2%, respectively, indicating that children are suffering more from cough or bronchitis as compared with previous years (Zhang et al., 2014). This alarming increase might be a serious risk to children from long-term cumulative exposure to polluted air in Nanchang. The consistency of parents' perception about general health status and respiratory conditions (allergies, bronchitis, upper respiratory infection, and coughing) in children indicated that parents' perceptions seemed to be credible.

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Parents have different levels of concern about the effects of worsening air pollution on their children's respiratory health. Such differences depend on educational levels, place of residence, household income levels, and travel experience. In particular, education and household income levels were positively correlated with the degree of parental concern.

This result is in agreement with a study showing that parents with higher educational levels and higher household income pay more attention to air quality, seek a better quality of life, and worry more about their children's health (Zhang et al., 2014). Another study revealed that the health effects of air pollution could also vary depending on socioeconomic status and the age of a population (Neidell, 2004). Our results are consistent with these findings. Parents who had national and/or international travel experience and resided in urban areas showed more concern about their children's health. Motor vehicle exhaust and dust caused by construction exacerbated parental concern about their children's health.

Our study has shown that parents perceive poor air quality to be linked with cough, dry throat pain (60.1%), and sneezing (49.5%) among exposed children. The majority of parents believed that motor vehicle emissions, secondhand smoke, and dust are the major influencing factors for adverse effects on their children's respiratory health. Our qualitative finding is in agreement with a report that used logistic regression to examine the effect of secondhand smoke exposure on public workers in Shanghai and suggested secondhand smoke was responsible for several respiratory health problems, including lung cancer and tracheitis (Li et al., 2009).

Aurrekoetxea and coauthors' (2016) study on secondhand smoke exposure on 4-yearold children in Spain showed 21.6% of the children were exposed to secondhand smoke at home and 47.1% elsewhere. The odds of quantifiable urinary cotinine in children dropped after the smoking ban took effect in public places. Quantifiable urinary cotinine was more likely in children whose parents smoked at home in their presence (Aurrekoetxea et al., 2016). It is important to prevent children from indoor exposure to lung irritants in order to promote their respiratory health. In particular, parents should be reminded that their activities, including smoking or using coal for cooking, can affect their children's health.

Based on the children's health risk factors associated with poor air quality, the government should take all possible measurements to improve air quality in Nanchang. Parents believe that the top three approaches for the government to improve air quality in Nanchang are to control and reduce pollution from industrial facilities, to increase public transportation and reduce use of private cars, and to control and reduce waste incineration. These findings were consistent with reports from other studies (Lee et al., 2014; Zhang et al., 2014), which is useful information to Nanchang government officials in their effort to control air pollution and improve air quality in Nanchang in the future.

This study was more complete than the 2013 survey study (Zhang et al., 2014) because it contained a larger sample size from both rural and urban areas, and included both healthy and sick children. Limitations, however, are present.

One limitation in this study is possible recall bias when parents answered questions on their children's respiratory status. Plus, the questionnaire didn't include parent's own contribution to air quality and the health of their children. The main limitation of this study is due to the focus on a narrowed target population: parents with children ages 2-10 years. Therefore, it is unclear if the perception about air quality and its effects on children's respiratory health is the same or different from parents who have children younger than 2 or older than 10 years.

Also, people living in cities usually believe their health is better than people living in the countryside, which might be a cognitive bias. Finally, the rating scale used in this survey is subjective to parental perception. More quantitative research should be conducted in order to obtain a more complete assessment about the effects of poor air quality on children's respiratory health in Nanchang, China.

Conclusion

Most parents who participated in this study reported believing that their children were in good health (69%). Parents' concern regarding their children's health, however, was quite different depending on their socioeconomic status and level of education. Promoting health education about how air quality affects children's health might be an effective measure to improve public knowledge and understanding of the effects of poor air quality, especially for low-socioeconomic status parents in the countryside who reported more worry about their children's health.

While it is true that air pollution is not a problem localized to any one city or country and it can be a serious health issue affecting many countries and regions of the world, the majority of parents who participated in this study believe that the government should place more control on industrial facilities, private cars, and waste incineration to improve the air quality and respiratory health conditions of children in Nanchang.

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In addition to posing great risks to children's respiratory health, air pollution is an issue that ideally should be addressed by the government, as air pollution is a far-reaching problem that affects all people exposed. Therefore, when making any economic development plan or policy for a city, proper management for air quality should be an essential consideration. The public's perception could provide a constructive frame of reference for the government to consider when shaping policies.

The government is not the only entity with a duty to improve the air quality and respiratory health of children--the public also has to assume some responsibility. Based on the populace's knowledge and misgivings, the public should consider stopping unhealthy behaviors (such as to stop smoking both indoors and outdoors), stopping indoor cooking with coal and using more cleaner fuels, and limiting their use of private cars in favor of using public transportation (buses) or personal bicycle more often.

Si Fan

Zhaokang Yuan, MS, MD

Xiong Liao

Hong Tu

Guilian Lan

School of Public Health, Nanchang University

Jay E. Maddock, MS, PhD

Yuanan Lu, MS, PhD

School of Public Health, Nanchang University

Office of Public Health Studies, University of Hawaii at Manoa

Acknowledgements: The authors want to express their great appreciation to the following collaborating agencies for their support of this study: East Lake District CDC and Jiangxi Provincial Children's Hospital, which provided support on the survey, especially East Lake District Kindergarten in Nanchang and Gaoxin District Primary School in Nanchang. This study was funded by Nanchang University through Dr. Yuanan Lu's Ganjiang Chair Professorship.

Corresponding Author: Yuanan Lu, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI 96822.

E-mail: yuanan@hawaii.edu.

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TABLE 1
General Demographic Characteristics of Interviewees (N = 989)
 
Characteristic                                   #       %
 
Gender
  Male                                          373    37.7
  Female                                        616    62.3
Educational level
  [less than or equal to] Junior high school    267    27.0
  High school                                   207    20.9
  [greater than or equal to] College            515    52.1
Place of residence
  City                                          660    66.7
  Countryside                                   329    33.3
Average annual household income (yuan)
  <25,000                                       379    38.3
  25,000-75,000                                 402    40.6
  >75,000                                       208    21.0
Parents' age (years) *
  20-30                                         305    30.8
  31-40                                         604    61.1
  >40                                           76      7.7
Travel experience
  Yes                                           919    92.9
  Domestic travel                               817    82.6
  Overseas travel                               102    10.3
  No                                            70      7.1
Health status of child
  Healthy                                       496    50.2
  Sick (selected in hospital)                   493    49.8
 
* Mean age = 33.2; Standard deviation = 5.1.
 
TABLE 2
Parents' Perceptions of Children's General Health Conditions
 
Parent Characteristic                  Perceived General
                                       Health Condition
 
                                     Good         Fair
 
                                   #      %      #      %
Gender
  Male                           269    72.1    86    23.1
  Female                         415    67.4   160    26.0
Educational level
  [less than or equal to]        179    67.0    67    25.1
    Junior high school
  High school                    132    63.8    61    29.5
  [greater than or               373    72.4   118    22.9
    equal to] College
Place of residence (a)
  City                           474    71.8   157    23.8
  Countryside                    210    63.8    89    27.1
Average annual household
income (yuan)
  <25,000                        260    68.6    96    25.3
  25,000-75,000                  273    67.9   102    25.4
  >75,000                        151    72.6    48    23.1
Parents' age (years) (b)
  20-30                          180    59.0    91    29.8
  31-40                          448    74.2   134    22.2
  >40                             53    69.7    21    27.6
Travel experience
  Yes                            659    71.7   215    23.4
  Domestic travel                581    71.1   194    23.7
  Overseas travel                 78    76.5    21    20.6
  No                              25    35.7    31    44.3
Health status of child (c)
  Healthy                        437    88.1    57    11.5
  Sick (selected in hospital)    247    50.1   189    38.3
 
                                   Perceived
                                     General
                                     Health
                                   Condition    [chi      p-
Parent Characteristic                Poor      square]   Value
 
                                   #      %
Gender                                          2.857    .240
  Male                            18    4.8
  Female                          41    6.7
Educational level                               7.704    .103
  [less than or equal to]         21    7.9
    Junior high school
  High school                     14    6.8
  [greater than or                24    4.7
    equal to] College
Place of residence (a)                         11.181    .004
  City                            29    4.4
  Countryside                     30    9.1
Average annual household                        2.128    .712
income (yuan)
  <25,000                         23    6.1
  25,000-75,000                   27    6.7
  >75,000                          9    4.3
Parents' age (years) (b)                       36.639    <.001
  20-30                           34    11.1
  31-40                           22    3.6
  >40                              2    2.6
Travel experience                              48.469    <.001
  Yes                             45    4.9
  Domestic travel                 42    5.1     1.645    .439
  Overseas travel                  3    2.9
  No                              14    20.0
Health status of child (c)                     174.87    <.001
  Healthy                          2    0.4
  Sick (selected in hospital)     57    11.6
 
(a) Orderly rank and inspection: Z = -2.846, p = .004.
 
(b) Spearman rank correlation coefficient = -0.141, p = .000;
Linear trend value = 22.253, p = .000.
 
(c) Orderly rank and inspection: Z = -13.191, p = .000.
 
TABLE 3
Frequency of Respiratory Conditions in Children
 
                               Never        < 1/yr       1-2/yr
Date          Disease          # (%)        # (%)        # (%)
 
April 2014    Asthma         898 (90.8)    47 (4.8)     20 (2.0)
(n = 989)     Allergies *    716 (72.4)   152 (15.4)    65 (6.6)
              Bronchitis *   522 (52.8)   188 (19.0)   175 (17.7)
              URI *          268 (27.1)   163 (16.5)   321 (32.5)
              Coughing *      94 (9.5)    177 (17.9)   370 (37.4)
              Wheezing *     876 (88.6)    53 (5.4)     28 (2.8)
 
May 2013      Asthma         660 (91.5)    39 (5.4)     11 (1.5)
(n = 721)     Allergies      546 (75.7)   103 (14.3)    36 (5.0)
              Bronchitis     510 (70.7)   112 (15.5)    47 (6.5)
              URI            76 (10.5)    176 (24.4)   216 (30.0)
              Coughing       124 (17.2)   168 (23.0)   191 (26.5)
              Wheezing       661 (91.7)    37 (5.1)     7 (1.0)
 
                                           Chronic
                               >3/yr       Illness
Date          Disease          # (%)        # (%)
 
April 2014    Asthma          21 (2.1)     3 (0.3)
(n = 989)     Allergies *     48 (4.9)     8 (0.8)
              Bronchitis *    98 (9.9)     6 (0.6)
              URI *          228 (23.1)    9 (0.9)
              Coughing *     335 (33.9)    13 (1.3)
              Wheezing *      29 (2.9)     3 (0.3)
 
May 2013      Asthma          6 (0.8)      3 (0.7)
(n = 721)     Allergies       15 (2.1)     21 (2.9)
              Bronchitis      30 (4.2)     22 (3.1)
              URI            186 (25.8)    67 (9.3)
              Coughing       171 (23.7)    69 (9.6)
              Wheezing        10 (1.4)     6 (0.8)
URI = upper respiratory infection.
 
* Compared with 2013, p <.001.
 
TABLE 4
Correlations Between Parents' Perception of Their Child's Health
and Respiratory Conditions in Children *
 
               General
                Health
Disease       Conditions     p-Value
 
Asthma           0.037         .244
Allergies        0.095         .003
Bronchitis       0.173        <.001
URI              0.218        <.001
Coughing         0.204        <.001
Wheezing         0.047         .141
 
URI = upper respiratory infection.
 
* The Spearman rank correlation coefficients between
perceptions of general health conditions and

respiratory diseases in children.
 
TABLE 5
Parent Concerns About Child's Respiratory Health When Air Quality
Worsened
                                                    Somewhat
Parent Characteristic             Very Worried      Worried
 
                                   #       %       #       %
Gender
  Male                            164    44.0     178    47.7
  Female                          318    51.6     260    42.2
Educational level
  [less than or equal to]         100    37.5     133    49.8
    Junior high school
  High school                     94     45.4     97     46.9
  [greater than or equal          288    55.9     208    40.4
    to] College
Place of residence
  City                            349    52.9     156    47.4
  Countryside                     133    40.4     282    42.7
Average annual household
income (yuan)
  <25,000                         161    42.5     185    48.8
  25,000-75,000                   201    50.0     171    42.5
  >75,000                         120    57.7     82     39.4
Parents' age (years) (b)
  20-30                           148    48.5     136    44.6
  31-40                           297    49.2     269    44.5
  >40                             35     46.1     31     40.8
Travel experience
  Yes                             453    49.3     407    44.3
  Domestic travel                 390    47.7     369    45.2
  Overseas travel                 63     61.8     38     37.3
  No                              29     41.4     31     44.3
 
                                       Not
Parent Characteristic              Considered      Not Worried
 
                                   #       %       #       %
 
Gender
  Male                            21      5.6     10      2.7
  Female                          23      3.7     15      2.4
Educational level
  [less than or equal to]         20      7.5     14      5.2
    Junior high school
  High school                     11      5.3      5      2.4
  [greater than or equal          13      2.5      6      1.2
    to] College
Place of residence
  City                            28      8.5     12      3.6
  Countryside                     16      2.4     13      2.0
Average annual household
income (yuan)
  <25,000                         19      5.0     14      3.7
  25,000-75,000                   20      5.0     10      2.5
  >75,000                          5      2.4      1      0.5
Parents' age (years) (b)
  20-30                           14      4.6      7      2.3
  31-40                           23      3.8     15      2.5
  >40                              7      9.2      3      3.9
Travel experience
  Yes                             39      4.2     20      2.2
  Domestic travel                 38      4.7     20      2.4
  Overseas travel                  1      1.0      0      0.0
  No                               5      7.1      5      7.1
 
                                  [chi
Parent Characteristic            square]   p-Value
 
Gender                            6.322     .097
  Male
  Female
Educational level                38.591     <.001
  [less than or equal to]
    Junior high school
  High school
  [greater than or equal
    to] College
Place of residence               28.803     <.001
  City
  Countryside
Average annual household         17.707     .007
income (yuan)
  <25,000
  25,000-75,000
  >75,000
Parents' age (years) (b)          5.966     .743
  20-30
  31-40
  >40
Travel experience                 8.402     .038
  Yes
  Domestic travel                10.278     .016
  Overseas travel
  No
 
(a) Nonparametric rank and inspection: [chi square] = 32.797,
p = .000; Spearman rank correlation coefficient = 0.182,
p = .000; Linear trend value = 37.456, p = .000.
 
(b) Nonparametric rank and inspection: Z = -4.449, p = .000.
 
(c) Nonparametric rank and inspection: [chi square] = 15.182,
p = .000; Spearman rank correlation coefficient = 0.123,
p = .000; Linear trend value = 16.338, p = .000.
 
TABLE 6
Analysis of Risk Factors (Parents' Perception) Related to Children's
Respiratory Conditions
 
                                                       Upper
                                                     Respiratory
                                   Bronchitis (a)   Infection (b)
 
Factors *                           Yes     No      Yes     No
 
Dust           Did not affect       23      47      38      32
               Affected a little    130     176     216     90
               Affected strongly    314     299     467     146
 
Automobile     Did not affect       12      29      21      20
emission       Affected a little    102     135     162     75
               Affected strongly    353     358     538     173
 
Second-        Did not affect       23      22      34      11
hand           Affected a little    94      140     164     70
smoke          Affected strongly    350     360     523     187
 
                                    Coughing (c)
 
Factors *                           Yes     No
 
Dust           Did not affect       57      13
               Affected a little    276     30
               Affected strongly    562     51
 
Automobile     Did not affect       33       8
emission       Affected a little    212     25
               Affected strongly    650     61
 
Second-        Did not affect       37       8
hand           Affected a little    214     20
smoke          Affected strongly    644     66
 
* The effect rank of factors that parents believed worsen
child respiratory symptoms.
 
(a) Dust (bronchitis): [chi square] = 12.491, p = .002; rs = 0.109,
p = .031. Automobile emission (bronchitis): [chi square] =
8.647, p = .013;
 
[r.sub.s] = 0.083, p = .009. Secondhand smoke (bronchitis):
[chi square] = 6.166, p = .046; [r.sub.s] = 0.061, p = .032.
 
(b) Dust (upper respiratory infection): [chi square] =
16.449, p = .000; [r.sub.s] = 0.109, p = .001. Automobile
emission (upper respiratory infection): [chi square] =
14.992, p = .001; [r.sub.s] = 0.107, p = .001.
 
(c) Dust (coughing): [chi square] = 7.723, p = .021;
[r.sub.s] = 0.064, p = .044.
 
FIGURE 1
Exhibited Symptoms as a Result of Worsened Air Quality
 
                                   Yes    No
 
Did Not Affect                      49   940
Other                               16   973
Irritability                       125   864
Skin Allergies                     210   779
Sneezing                           490   499
Dry or Sore Throat                 594   395
Stinging, Burning, or Itchy Eyes   230   759
Difficulty Breathing               100   889
Cough                              373   616
 
Note: Table made from bar graph.
 
FIGURE 2
Factors That Worsened Children's Symptoms
 
                              Affected   Not Affected
 
Smog                            902           87
Dust                            919           70
Automobile Emission             948           41
Lack of Air Circulation due
  to Tall Building Wall         685          304
Construction                    812          177
Chemical                        828          161
Secondhand Smoke                944           45
 
Note: Table made from bar graph.
[GRAPHIC OMITTED]

[GRAPHIC OMITTED]

[GRAPHIC OMITTED]

Full Text: COPYRIGHT 2017 National Environmental Health Association
Source Citation
Fan, Si, et al. "A study of parents' perception of air pollution and its effect on their children's respiratory health in Nanchang, China." Journal of Environmental Health 79.7 (2017): E1+. Global Reference on the Environment, Energy, and Natural Resources. Web. 18 Nov. 2017.
URL
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