# From Perception to Action: Air Pollution Awareness and Behavioral Adjustments in Pregnant Women in Serbia

## TL;DR

Pregnant women in Serbia perceive poor air quality but often lack guidance on protective behaviors, highlighting a need for better communication and support.

## Contribution

This study identifies socio-economic and spatial factors influencing air pollution perception and behavioral responses among pregnant women in Serbia.

## Key findings

- Most pregnant women perceive air quality as poor, relying on unofficial sources like social media.
- Proximity to urban areas and water correlates with negative perceptions, while forests correlate with positive assessments.
- Only half of participants modified behaviors, and none received professional guidance on air pollution risks.

## Abstract

In regions with sustained air pollution, the adoption of protective health behaviors is critical, particularly among pregnant women—a population marked by physiological vulnerability and heightened receptivity to preventive guidance. Understanding and supporting patient-driven behavioral change requires attention to individual perception and awareness, which are shaped by socio-economic and spatial factors, as well as access to credible information. Objectives: This study investigates how pregnant women in Serbia perceive air quality, identifies determinants that influence these perceptions, and evaluates the extent and nature of behavioral adaptations undertaken to mitigate exposure-related risks. Methods: A cross-sectional survey was conducted among 279 pregnant women using a structured, researcher-administered questionnaire. Collected data included demographic and psychosocial variables, air quality perceptions, self-reported health effects, and behavioral responses. Residential proximity to land-use attributes was assessed using GIS-based spatial analysis. Results: Most participants perceived air quality as poor (68.8%), primarily informed by unofficial sources such as mobile applications and social media. Living close to continuous urban fabric (OR = 0.180, 95% CI: 0.059–0.558, p = 0.003) and water (OR = 0.306, 95% CI: 0.127–0.738, p = 0.008) was associated with poorer perceptions, while proximity to forests (OR = 2.938, 95% CI: 1.323–6.525, p = 0.008) correlated with more favorable assessments. Despite prevalent concern, around half of respondents (50.2%) reported no behavioral modifications. Importantly, none had received guidance from healthcare professionals on the topic. Conclusions: These findings highlight critical gaps in environmental health literacy and provider engagement. Integrating tailored communication and behavioral support in existing prenatal counseling could advance health-related quality of life in this vulnerable population.