Factors related to protective behaviors and interventions targeting PM2.5 exposure reduction: a systematic review

Fine particulate matter (PM_2.5) exposure presents a significant global health burden. While policy interventions remain essential for emission reduction, individual-level protective behaviors may mitigate immediate exposure. However, the effectiveness of these interventions and factors influencing their adoption remain incompletely characterized. This systematic review aims to (1) characterize protective behaviors and interventions targeting PM_2.5 exposure reduction, (2) evaluate their effectiveness, (3) identify factors influencing their adoption, and (4) synthesize evidence across diverse exposure contexts. Following PRISMA guidelines, we searched three electronic databases (PubMed, Scopus, and Embase) for studies published between 2015 and 2024 that examined protective behaviors or interventions against air pollution exposure reduction. Quality assessment employed design-specific tools (Cochrane Risk of Bias 2.0, STROBE, MMAT, NOS). Data were synthesized using a PICOS framework (Population, Intervention, Comparison, Outcomes, Study design). Thirteen studies met the inclusion criteria. Interventions comprised technological solutions (air purifiers, masks), structural modifications (ventilation improvements), and behavioral adaptations (activity reduction). A randomized controlled trial demonstrated that multi-component interventions reduced PM_2.5 exposure by 5.7μg/m³ with corresponding health improvements in asthma patients. Modeling evidence suggested that protective behaviors could reduce PM_2.5-associated mortality by 5.7% in highly polluted regions. Psychosocial factors, particularly risk perception, self-efficacy (β=0.47), and social norms (β=0.37), consistently predicted protective behavior adoption. Significant contextual differences existed across exposure settings, varying intervention effectiveness by pollution source and socioeconomic context. This review provides evidence supporting multi-component PM_2.5 reduction interventions targeting exposure pathways and behavior's psychosocial determinants. Contextual tailoring is essential for intervention effectiveness.