The awareness-distress paradox: Traffic-related air pollution awareness and psychological distress among the parents of urban schoolchildren in a northeastern province, Thailand

Urban air pollution is increasingly recognized as a mental-health risk, yet its impact on parents of schoolchildren remains understudied, particularly in rapidly urbanizing Southeast Asian cities. This study examined the prevalence of, and factors associated with, psychological distress related to traffic-related air pollution (TRAP) awareness and exposure among parents of urban schoolchildren in Khon Kaen Municipality, a major urban center in northeastern Thailand. A cross-sectional study surveyed 557 parents from two primary schools in high-traffic areas during March–May 2025, Thailand’s hot/dry high-pollution season. Structured interviews assessed sociodemographic characteristics, air pollution awareness and exposure, health behaviors, physical symptoms, and psychological distress using a validated 10-item questionnaire. Data were analyzed by bivariate and multivariable logistic regression with backward elimination (α = 0.05). Moderate-to-high psychological distress affected 61.94% of parents (95% confidence interval [CI]: 57.87–65.85). Higher air pollution awareness showed the strongest association with distress, following a graded pattern (moderate: adjusted odds ratio [AOR] = 2.41, 95%CI: 1.56–3.72; high: AOR = 4.39, 95%CI: 2.33–8.30). Other significant factors were moderate-to-appropriate health behaviors (AOR = 3.36, 95%CI: 2.14–5.26), air quality monitoring app use (AOR = 1.79, 95%CI: 1.17–2.74), and four to five affected body systems (AOR = 2.16, 95%CI: 1.32–3.53). A cross-sectional awareness–distress pattern was identified, whereby greater air pollution awareness was associated with higher psychological distress; the design does not permit conclusions about direction of effect. School-based air-quality communication in traffic-exposed urban settings should pair risk information with practical protective guidance and mental-health support for caregivers, relevant to rapidly urbanizing cities across Southeast Asia and beyond.