Abstract Rationale Climate change has dramatically increased wildfire frequency and intensity, exposing millions to hazardous air quality. While public health messaging emphasizes protective behaviors (air purifiers, N95 masks, air quality monitoring), the temporal patterns of protection-seeking behavior remain poorly characterized. We hypothesized that, populations demonstrate predominantly reactive rather than proactive protective responses to wildfire smoke, seeking protection only after hazardous exposure occurs. Methods We conducted a digital epidemiology study analyzing Google Trends search data during the June 2023 Canadian wildfire smoke event affecting the North-eastern United States. We examined searches for protective behaviors (air purifier, N95 masks, air quality index) across six Metropolitan Statistical Areas (MSAs) representing diverse socioeconomic profiles. Search timing was classified as preparedness (1-7 days before local Air Quality Index AQI exceeded 150) versus reactive (during/after AQI 150 on June 6-8, 2023). Air quality data from EPA AirNow stations were matched to MSA-level search volumes. We compared temporal patterns between high-income (New York, Boston, Washington DC; median income 72, 000-95, 000) and low-income (Syracuse, Reading, Scranton; median income 54, 000-62, 000) MSAs. Results Analysis revealed universal reactive behavior regardless of socioeconomic status. Across all MSAs, 92% of protective behavior searches occurred during or after smoke arrival, with only 8% occurring in the preparedness window. Both high-income and low-income communities demonstrated 10-fold increases in protective searches during the peak smoke period (June 6-8) compared to baseline. High-income MSAs showed mean search interest increase from 6. 2 to 66. 4 (10. 7-fold), while low-income areas increased from 6. 5 to 66. 1 (10. 2-fold). New York City demonstrated the highest reactive spike at 14. 8-fold increase. The dramatic spike coincided precisely with AQI exceeding 150, indicating populations sought protection only after hazardous exposure began rather than preparing in advance despite available air quality forecasts Conclusions This analysis reveals a critical failure in wildfire smoke preparedness across all socioeconomic strata: populations universally seek protection only after hazardous exposure begins. The absence of preparedness behavior despite available air quality forecasting represents a fundamental gap in public health communication and resource distribution systems. Achieving effective wildfire smoke protection requires structural interventions: (1) pre-positioned protective equipment distribution programs, (2) community preparedness programs ensuring protective resources are accessible before smoke arrives, and (3) subsidized access to air purifiers and N95 masks for vulnerable populations. With wildfire exposure projected to increase 30-50% by 2050, addressing this universal reactive behavior gap is essential to prevent escalating respiratory morbidity in all communities. This abstract is funded by: None
Asante et al. (Fri,) studied this question.