Avoiding Exposure to Air Pollution by Using Filtering Facemask Respirators: An Application of the Health Action Process Approach Guangyu Zhou Freie Universität Berlin Yiqun Gan and Qin Ke Peking University Nina Knoll Freie Universität Berlin Chris Lonsdale Australian Catholic University Ralf Schwarzer Australian Catholic University, and University of Social Sciences and Humanities Objectives: Adherence to the use of filtering facemask respirators on hazy days to reduce exposure to air pollution is examined with the aim of uncovering psychological mechanisms that may be responsible for individual differences in motivation and behavior. Methods: In a longitudinal survey, 164 young adults from Beijing, China, completed assessments at baseline (Time 1), 2 weeks (Time 2), and 4 weeks later (Time 3). Self-efficacy, risk perception, and outcome expectancies were measured along with intention at Time 1, planning and action control at Time 2, and facemask use at Time 3. A structural equation model was specified to test theory-implied pathways of influence. Results: Self-efficacy and risk perception jointly predicted behavioral intention at Time 1. Planning and action control at Time 2 jointly predicted behavior at Time 3, serving as parallel mediators between intention (Time 1) and facemask use (Time 3). The model explained 19.5% and 30.2% of the variance in intention and behavior, respectively. Conclusions: Results support theory-based psychological mechanisms, with a focus on planning and action control, which might be influential in the adoption and maintenance of self-protective facemask wearing. Keywords: intention, action control, planning, facemask wearing, air pollution Beijing is one of the most air-polluted mega cities in the world with over 100 hazy days every year (Chen, Wang, Ma, & Zhang, 2013; Langrish et al., 2009). Combustion of coal is the most important source of primary particulate matter (PM2.5) that is prone to carrying a variety of toxic heavy metals, acid oxides, organic pollutants, and microorganisms. These substances can deposit in human alveoli where they cause lung diseases, and they can enter the bloodstream leading to cardiovascular prob- lems. Thus, exposure to PM2.5 can increase morbidity and mortality from respiratory and cardiovascular diseases and can- cer (Brunekreef & Holgate, 2002). The Chinese Center for Disease Control and Prevention (2013) has recommended several individual actions to reduce personal exposure to ambient air pollution on high air pollution days, including staying indoors, cleaning indoor air with air filters, and wearing filtering facemask respirators (also called disposable res- pirators, dusk masks, breathing masks, or facemasks). Cancelling outdoor activities to reduce exposure to air pollution is an unat- tractive choice for most people. Therefore, the use of facemasks is the most effective and common choice to avoid exposure when outdoors (Langrish et al., 2009; Singh et al., 2010). However, adherence to wearing respiratory protective devices is below rec- ommended levels. One recent study, using a stratified cluster random sampling method with 1,961 residents of Beijing, found that 58.6% wore facemasks on hazy days (Jia & Cai, 2014). In other words, despite the health risks, about half of the respondents did not adhere to public health authorities’ recommendations re- garding preventive behavior. Therefore, interventions are needed to increase facemask use. Such interventions require a theoretical foundation from which to identify possible mechanisms of health behavior change. Theoretical Models for Understanding Adherence to Facemask Use Earlier studies on the use of facemasks have been conducted during the outbreak of pandemic influenza when people are likely to be exposed to airborne virus. Several health behavior change models have been found to provide a meaningful explanation of This article was published Online First August 10, 2015. Guangyu Zhou, Department of Educational Science and Psychology, Freie Universität Berlin; Yiqun Gan and Qin Ke, Department of Psychol- ogy, Peking University; Nina Knoll, Department of Educational Science and Psychology, Freie Universität Berlin; Chris Lonsdale, Institute for Positive Psychology and Education, Australian Catholic University; Ralf Schwarzer, Institute for Positive Psychology and Education, Australian Catholic University, and Department of Clinical, Health, and Rehabilita- tion Psychology, University of Social Sciences and Humanities. Correspondence concerning this article should be addressed to Yiqun Gan, Department of Psychology, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, P.R. China 200871. E-mail: ygan@pku.edu.cn This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Health Psychology © 2015 American Psychological Association 2016, Vol. 35, No. 2, 141–147 0278-6133/16/$12.00 http://dx.doi.org/10.1037/hea0000264 141