1. airTEXT EEA-PROMOTE USER WORKSHOP ON GMES ATMOSPHERIC SERVICES 12-13 June, 2008, Copenhagen Presented by Stephen Potter, Head of Pollution, London Borough of Croydon Christine McHugh CERC Monday 7 February 2005

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. Signing up

9. 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 MODERATE AIR POLLUTION HIGH AIR POLLUTION VERY HIGH AIR POLLUTION 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?  You may notice mild health effects  You are unlikely to need to take any action but be aware of your symptoms  Take 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?  You are unlikely to need to take any action but be aware of symptoms  Take reliever medication with you as a precaution  Talk to your doctor if you have concerns  Keep reliever medication with you as a precaution  You may need to increase dose of reliever medication – BUT NEVER EXCEED THE STATED DOSE  Consider reducing exposure by spending less time outdoors  Try to avoid strenuous outdoor activity.  Talk to your doctor if you have concerns  Keep reliever medication with you  Increase dose of reliever medication if you are affected – NEVER EXCEED THE STATED DOSE  Avoid long periods outdoors  Avoid strenuous outdoor activity.  Talk to your doctor if you have concerns

10. airTEXT – Mode of delivery

11. Message contents Summary of findings of review and assessment for Croydon 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.

12. 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

13. Independent Evaluation University of Brighton commissioned to undertake an independent evaluation of airTEXT. Stage 1: AIM: identify barrier to participation Identify target population Breath Easy groups (age bias?) Respiratory clinics Asthma nurses Heart /angina rehabilitation groups Recruit participants for 2-3 focus groups Mixed age and ethnic origin Geographical diversity

14. Independent Evaluation Stage 2: AIM: assessing the effectiveness of airTEXT Snap shot sampling (high & low pollution days) Activity diaries Symptoms questionnaire Peak flow measurements Recruit participants Mixed age and race Geographical diversity

15. airTEXT – Number of subscribers

16. airTEXT – Monthly growth

17. airTEXT – Subscribers by Borough

18. 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

19. airTEXT – Validation

21. 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.

22. airTEXT – Validation : Ozone

23. airTEXT – Validation : NO 2

24. airTEXT – Validation : PM 10

25. airTEXT – Validation : SO 2

26. www.airtext.info