airTEXT

EEA-PROMOTE USER WORKSHOP ON GMES ATMOSPHERIC SERVICES12-13 June, 2008, Copenhagen

Presented byStephen Potter, Head of Pollution, London Borough of Croydon

Christine McHughCERC

Monday 7 February 2005

What is airTEXT?

• Free air pollution alert and health advice service for people vulnerable to air pollution:

• Asthma• Emphysema, bronchitis (COPD)• Heart disease and angina

• Alerts sent by:

• SMS (text message)• Voice message to home landline phones• E-mail

Why airTEXT?

• Born of the need to improve access to air quality information by vulnerable groups.

• Air pollution information and health advice widely available, but passively, not actively disseminated and take-up rates were low.

• Desire to target information in a timely way directly to those most at risk.

airTEXT aims

• enable patients to self-manage their symptoms & reduce exposure

• reduce acute impacts of air pollution (accident and emergency treatment – visit to doctor)

• improve patient quality of life and address health inequalities

• reduce resource implications on National Health Service

• evaluate health intervention

airTEXT and PROMOTE

• 2005 Croydon approached CERC to use YourAir service as forecasts for airTEXT.

• June 2005 Croydon Council joined PROMOTE as a user with CERC as Service Provider.

• Pilot airTEXT project undertaken in Croydon Jul-Nov 2005 using SMS message dissemination.

• Nov 05-Mar 07 airTEXT alerts also issued via e-mail and voice message to fixed line (home) telephones.

airTEXT London wide

• In March 2007 airTEXT was extended to all London boroughs & Slough with funding from PROMOTE, Mayor of London, Defra and the boroughs

• Consortium of 22 boroughs manage airTEXT

• Supported by:•Environment Agency•Health Protection Agency•Greater London Authority

• Current airTEXT subscribers: 1850

How airTEXT works

YourAir

Pollution

forecast

for London

Preparation of

generic

area forecast

Moderate?

High?

Very High?

Pollution levels

Preparation of

voice message

and e-mail

(automated text alert)

Dissemination

of message via

text, voice, and

e-mail

Signing up

How airTEXT works

• airTEXT alerts triggered on days of elevated air pollution:

• MODERATE• HIGH• VERY HIGH

• Alerts sent:

• 6-7 p.m. on evening before an air pollution episode or• 7-8 a.m. on morning of an air pollution episode

MODERATEAIR POLLUTION

HIGHAIR POLLUTION

VERY HIGHAIR POLLUTION

What the message will say: What the message will say: What the message will say:

MODERATE air pollution TOMORROW. You may notice mild health effects but these are unlikely to require action. If you have concerns please contact your GP.

HIGH air pollution TOMORROW. If affected consider reducing exposure: spend less time outdoors and take reliever medication. If unwell contact your GP.

VERY HIGH air pollution TOMORROW. Consider reducing exposure: spend less time outdoors and take reliever medication. If unwell contact your GP.

What effects will I notice? What effects will I notice? What effects will I notice?

You may notice mild health effectsYou are unlikely to need to take any action but be aware of your symptomsTake reliever medication with you as a precaution

You may notice significant effects such as wheezing or more difficulty in breathing or chest pains if you have a heart condition

You may notice a worsening of breathing difficulties or chest pains if you have a heart condition

What should I do? What should I do? What should I do?

You are unlikely to need to take any action but be aware of symptomsTake reliever medication with you as a precautionTalk to your doctor if you have concerns

Keep reliever medication with you as a precautionYou may need to increase dose of reliever medication – BUT NEVER EXCEED THE STATED DOSEConsider reducing exposure by spending less time outdoorsTry to avoid strenuous outdoor activity.Talk to your doctor if you have concerns

Keep reliever medication with youIncrease dose of reliever medication if you are affected – NEVER EXCEED THE STATED DOSEAvoid long periods outdoorsAvoid strenuous outdoor activity.Talk to your doctor if you have concerns

airTEXT – Mode of delivery

Morning28%

Evening72%

Message contents

MODERATE

MODERATE air pollution TOMORROW. You may notice mild health effects but these are unlikely to require action. If you have concerns please contact your GP.

HIGH

HIGH air pollution TOMORROW. If affected consider reducing exposure: spend less time outdoors and take reliever medication. If concerned contact your GP.

VERY HIGH

VERY HIGH air pollution TOMORROW. If affected consider reducing exposure: spend less time outdoors and take reliever medication. If concerned contact your GP.

Croydon pilot – evaluation Sept 2006

• At least 80% of users think airTEXT has helped them manage symptoms better and avoid exposure to air pollution

• 94% find it useful or very useful

• 89% more aware of pollution episodes and 71% have changed the way they respond

• Breatheasy groups, chest clinics etc, very pleased with service

Independent Evaluation

University of Brighton commissioned to undertake an independent evaluation of airTEXT.

Stage 1: AIM: identify barrier to participation

Identify target populationBreath Easy groups (age bias?)Respiratory clinics Asthma nurses Heart /angina rehabilitation

groups

Recruit participants for 2-3 focus groups Mixed age and

ethnic originGeographical

diversity

Independent EvaluationStage 2: AIM: assessing the effectiveness of airTEXT

Snap shot sampling (high & low pollution days)Activity diariesSymptoms questionnairePeak flow measurements

Recruit participantsMixed age and raceGeographical diversity

airTEXT – Number of subscribers

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08

airTEXT – Monthly growth

0

100

200

300

400

500

600

Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08

airTEXT – Subscribers by Borough

Legend

lonboro

SUBSCRIBER

7 - 19

26 - 36

41 - 53

61 - 90

100 - 122

247

airTEXT – Validation

• An alert is issued in a Borough if the Total Pollution Index is MODERATE (>3) or HIGH (>6) over an area exceeding 10% of the Borough. The issuing of alerts is assessed by comparing the alerts issued with measured air pollution concentrations at Automated Urban & Rural Network (AURN) sites in Greater London with respect to the following parameters:

• i)       Alert Accuracy = total number of correct alerts issued / total number of alerts issued

• ii)     Proportion of episodes correctly forecast for tomorrow = total number of episodes forecast / total number of episodes observed

airTEXT – Validation

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#Y AURN sites#Y LAQN Sites

airTEXT – Validation

Number of

monitored episodes

Number of alerts issued

Number of correct

alerts

Number of missed episodes

Number of false alerts

Alert accuracy

Episodes correctly forecast

Apr-07 17 8 7 10 1 88% 41% May-07 11 6 6 5 0 100% 55% Jun-07 10 5 4 6 1 80% 40% Jul-07 0 1 0 0 1 0% - Aug-07 6 5 4 2 1 80% 67% Sep-07 0 0 0 0 0 - - Oct-07 0 4 0 0 4 0% - Nov-07 6 1 0 6 1 0% 0% Dec-07 8 1 1 7 0 100% 13% Jan-08 1 0 0 1 0 - 0% Feb-08 4 1 1 3 0 100% 25% Mar-08 3 1 0 3 1 0% 0% Total 58 31 22 36 9 71% 38%

airTEXT – Index and bands

• In the UK the COMEAP (Committee on Medical Effects of Air Pollution Episodes) system is generally used. The system uses a 1-10 index divided into four bands

1-3 (Low) 4-6 (Moderate) 7-9 (High) 10 (Very High)

• The UK Department of the Environment (DEFRA) measures forecast accuracy by the percentage of forecasts in the correct band +/- 1 band.

airTEXT – Validation : Ozone

Percentage of days with calculated banding within +/- 1

London Bexley 90% London Bloomsbury 95% London Brent 89% London Eltham 86% London Hackney 92% London Haringey 86% London Harlington 89% London Hillingdon 90% London Lewisham 96% London Marylebone Rd 97% London N. Kensington 85% London Southwark 92% London Teddington 83% London Wandsworth 89% London Westminster 88%

airTEXT – Validation : NO2

Percentage of days with calculated banding within +/- 1

Camden Kerbside 93% Haringey Roadside 99% London Bexley 99% London Bloomsbury 99% London Cromwell Road 2 99% London Eltham 100% London Haringey 99% London Harlington 99% London Hillingdon 99% London Marylebone Road 73% London N. Kensington 98% London Southwark 100% London teddington 99% London Westminster 100% Tower Hamlets Roadside 97%

airTEXT – Validation : PM10

Percentage of days with calculated banding within +/- 1

Camden Kerbside 79% Haringey Roadside 85% London Bexley 90% London Bloomsbury 87% London Eltham 99% London Harlington 88% London Hillingdon 92% London Marylebone Road 42% London N. Kensington 88%

airTEXT – Validation : SO2

Percentage of days with calculated banding within +/- 1

London Bexley 99% London Bloomsbury 100% London Brent 100% London Cromwell Road 2 100% London Eltham 100% London Hillingdon 100% London Lewisham 100% London Marylebone Road 100% London N. Kensington 100% London Southwark 100% London Teddington 100% London Westminster 100%

www.airtext.info