PROTECTIVE BEHAVIORS DURING WILDFIRE SMOKE EVENTS: A MIXED METHODS STUDY OF PARENTS, CAREGIVERS, AND PREGNANT PEOPLE

Author

Emily A. CoyleFollow

Year of Award

2025

Document Type

Dissertation - Campus Access Only

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Public Health

Department or School/College

School of Public and Community Health Sciences

Committee Chair

Erin L. Landguth

Commitee Members

Annie Belcourt, Jim Caringi, Paul Lukacs, Curtis Noonan, Erin Semmens

Keywords

Missoula, Maternal, Young Children, PM2.5

Subject Categories

Community Health and Preventive Medicine | Environmental Public Health | Epidemiology | Maternal and Child Health | Public Health Education and Promotion

Recommended Citation

ABSTRACT Background: Wildfire smoke exposure poses significant health risks to young children and developing fetuses. The smoke contains fine particulate matter (PM₂.₅) linked to asthma, respiratory infections, and systemic inflammation. For pregnant people, exposure can contribute to pregnancy complications, while in-utero exposure can have lasting impacts on child development. More than seven million U.S. children are exposed annually, yet protective guidance is generally written for the public at large with little tailoring for caregivers or pregnant people. Few studies have evaluated how parents and caregivers adapt their behavior during smoke events. Purpose: This dissertation expands the understanding of how parents, caregivers, and pregnant people respond to wildfire smoke exposure by: (1) mapping existing public health guidance; (2) examining predictors of protective behaviors in Missoula County, Montana; and (3) integrating quantitative and qualitative findings to reveal not only what actions people take, but why. Methods: A scoping review (2008–2025) of 139 grey and peer-reviewed resources was conducted following PRISMA-ScR guidelines to map existing guidance and document protective behaviors. Quantitative data from a cross-sectional survey (n=154) of Missoula County parents, caregivers, and pregnant people were analyzed using multivariable logistic regression and marginal effects estimation to assess associations between socioeconomic indicators and protective behaviors. Regression results were integrated with open-ended qualitative survey responses (n=48) through a joint display, identifying areas of convergence, divergence, dissonance, and silence. Results: The scoping review confirmed that most guidance emphasized general measures such as staying indoors, monitoring AQI, and using HEPA filters, with few resources tailored to parents of young children or pregnant people. While protective behaviors were widely adopted, barriers such as costs, skepticism, and socioeconomic disparities were common. Higher education and financial stability predicted greater adoption of protective behaviors. Homeownership was associated with decreased likelihood of certain behavioral adaptations but greater adoption of in-home air quality improvements (e.g., HEPA/HVAC use). Qualitative data highlighted themes of pregnancy-related vigilance, skepticism about filter effectiveness, and uncertainty about exposure risk. Conclusion: Protective behaviors against wildfire smoke are widely practiced but unevenly distributed, shaped by socioeconomic status, housing conditions, and clarity of guidance. Pregnant people remain underrepresented in research and underserved in public health messaging. These findings highlight the need for equity-driven communication and population-specific interventions to mitigate disproportionate health burdens of wildfire smoke.