Young people’s experiences of breathing, air pollution and respiratory health in a large African city

Air pollution is a key contributor to poor respiratory health, particularly for those susceptible to its effects, such as adolescents whose lungs are still developing. Better understanding of the lived experiences of air pollution and lung health can support the design of policies and other interventions to improve health. The aim of this study was to explore adolescents’ lived experiences of breathing, lung health and air pollution in Nairobi, Kenya. We focused on adolescents who had reported respiratory symptoms and were attending schools in an informal settlement (Mukuru (n=22)) and an adjacent more affluent area (Buruburu (n=16)). We took a mixed-methods approach, combining video-recorded walking interviews with route tracking (GPS) and particulate pollution (PM2.5) measurements along the route. Participants took the interviewer to a space they found it harder to breathe and a space where they found it easier to breathe. Though both settlements had relatively high levels of PM2.5, Mukuru had more ‘hotspots’ of PM2.5, highlighting exposure inequalities for Nairobi residents. There was no significant difference in PM2.5 between spaces considered by interviewees as easier or harder to breathe in. Harder to breathe locations limited people’s activities within those spaces. The concept of ‘breathing well’ went beyond air quality, encompassing cleanliness, population and building density and presence of vegetation, offering potential for urban planning to support better lung health. Avoidance behaviours (for example walking faster) were a common way to reduce exposures. To supplement individual action, policies to reduce place-based inequalities and improve respiratory health for all are urgently needed.