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Cloete E, House A, Velasquez LD, Calderon M, Lopez J, Rivera R, Rivera L, Handley L. "I left my shyness behind": Sustainable community-led development and processes of motivation among rural Nicaraguan women. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:860-879. [PMID: 36041208 DOI: 10.1002/jcop.22926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
This paper explores motivational changes of Nicaraguan women involved in sustainable community-led development. Sustainability is the goal of many organizations engaged with capacity development interventions. Research on what such sustainability entails point to a correlation between sustained action by communities, postintervention, and high levels of social capital, collective agency, and efficacy. But what factors motivate people to develop the social capital, self-efficacy, and agency that enable them to sustain their actions towards their communities' well-being? Using Self-Determination Theory as framework, and drawing from interview data, this qualitative paper explores the psychosocial processes rural Nicaraguan women undergo when initially engaging in, and eventually committing to community-led projects. Types of motivation in combination with shifts from initial to more sustained forms of motivation, we conclude, can inform current and future community development interventions on the role motivation plays toward establishing agency, efficacy, and relationships-that is, essential components of sustainable community development.
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Affiliation(s)
- Elene Cloete
- Field Operations, Outreach International, Kansas City, MO, USA
| | - Alexandra House
- Field Operations, Outreach International, Kansas City, MO, USA
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Ye W, Pillarisetti A, de León O, Steenland K, Peel JL, Clark ML, Checkley W, Underhill LJ, Quinn A, Balakrishnan K, Garg SS, McCracken JP, Thompson LM, Díaz-Artiga A, Rosa G, Davila-Roman VG, de las Fuentes L, Papageorghiou AT, Chen Y, Wang J, Thomas FC. Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.23.23284847. [PMID: 36747716 PMCID: PMC9901046 DOI: 10.1101/2023.01.23.23284847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study. We assessed associations between PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm), BC (black carbon), and CO (carbon monoxide) exposures and blood pressure at baseline, prior to intervention, among 3195 pregnant women between 9 and 19 weeks of gestation. We measured 24-hour personal exposure to PM2.5/BC/CO and gestational blood pressure. Multivariable linear regression models were used to evaluate associations between personal exposures to three air pollutants and blood pressure parameters. Trial-wide, we found moderate increases in systolic blood pressure (SBP) and decreases in diastolic blood pressure (DBP) as exposure to PM2.5, BC, and CO increased. None of these associations, however, were significant at the 0.05 level. HAP exposure and blood pressure associations were inconsistent in direction and magnitude within each country. We observed effect modification by body mass index (BMI) in India and Peru. Compared to women with normal weights, obese women in India and Peru (but not in Rwanda or Guatemala) had higher SBP per unit increase in log transformed PM2.5 and BC exposures. We did not find a cross-sectional association between HAP exposure and blood pressure in pregnant women; however, HAP may be associated with higher blood pressure in pregnant women who are obese, but this increase was not consistent across settings.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Oscar de León
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lindsay J. Underhill
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, California, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada S. Garg
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - John P. McCracken
- Global Health Institute, Collage of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lisa de las Fuentes
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Jiang Y, Feng H, Jiao Z, Du Y, Li Y, Liu X, Tong S, Shao X, Li B, Sun H, Meng F, Shen Y, Li M, Zhao Q, Li D, Gao L, Fu X, Li F, Cui S, Zhang L, Zhang X, Liu L, Cao Y, Sun Y, Zhu C, Sun D, Zhang W, Gao Y. Environment and chronic disease in rural areas of Heilongjiang, China (ECDRAHC). BMJ Open 2023; 13:e063850. [PMID: 36653051 PMCID: PMC9853217 DOI: 10.1136/bmjopen-2022-063850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Environmental factors such as long-term exposure to cold can increase the risk of chronic diseases. However, few studies have focused on the impact of environmental factors and lifestyle changes on chronic diseases. To fully explore the association between exposure to environmental factors and the prevalent risk of various chronic diseases, we conducted a large cohort study (Environment and Chronic Disease in Rural Areas of Heilongjiang, China (ECDRAHC)). The ECDRAHC collected detailed questionnaire data covering 10 sections, physical measurements and blood and urine samples. In this study, we describe the design and implementation of the cohort study and present the findings for the first 10 000 participants. PARTICIPANTS The ECDRAHC study was carried out in rural areas where the annual average temperature is 2.9°C, and aimed to recruit 40 000 participants who are long-term residents aged 35-74 years. The participants will be followed up every 5 years. Currently, ECDRAHC has reached 26.7% (n=10 694) of the targeted population. FINDINGS TO DATE A total of 10 694 adults aged 35-74 years were recruited, including 61.7% women. The prevalence of current smokers was 46.8% in men and 35.4% in women. The mean blood pressure was 140.2/89.9 mm Hg and 135.7/85.0 mm Hg in men and women, respectively. The mean body mass index was 24.74 kg/m2 in men and 24.65 kg/m2 in women, with >7.3% being obese (>30 kg/m2). The main non-communicable diseases found in phase 1 were hypertension, diabetes, hypertriglyceridaemia and metabolic syndrome, with a higher prevalence of 51.0%, 21.6%, 46.8% and 42.6%, respectively. FUTURE PLANS We plan to complete the follow-up for the first phase of the ECDRAHC in 2024. The second and third phase of the cohort will be carried out steadily, as planned. This cohort will be used to investigate the relationship between environmental factors, lifestyle, and genetic and common chronic diseases.
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Affiliation(s)
- Yuting Jiang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Hongqi Feng
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Zhe Jiao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Yang Du
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Yuanyuan Li
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Xiaona Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Simeng Tong
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Xinhua Shao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - BingYun Li
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Hongna Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Fangang Meng
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Yuncheng Shen
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Mang Li
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Qiaoshi Zhao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Dandan Li
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Lin Gao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Xiaoyan Fu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Fuyuan Li
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Silu Cui
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Liwei Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Xiaoye Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Lixiang Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Yanhong Cao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Yafei Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Chenpeng Zhu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Wei Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
| | - Yanhui Gao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, People's Republic of China,National Health Commission & Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University(23618504), Harbin, People's Republic of China,Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, People's Republic of China,Center for Chronic Disease Prevention and Control, Harbin Medical University, Harbin, People's Republic of China
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Liu Y, Ning N, Sun T, Guan H, Liu Z, Yang W, Ma Y. Association between solid fuel use and nonfatal cardiovascular disease among middle-aged and older adults: Findings from The China Health and Retirement Longitudinal Study (CHARLS). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159035. [PMID: 36191716 DOI: 10.1016/j.scitotenv.2022.159035] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few studies have been conducted on the association between domestic solid fuel combustion and incident nonfatal cardiovascular disease (CVD). We assessed the prospective association between domestic fuel type and incident nonfatal CVD among Chinese adults aged ≥45 years. METHODS This was a prospective cohort study using data from the China Longitudinal Study of Health and Retirement (CHARLS) that recruited 8803 participants ≥45 years in 2013. Household fuel types were assessed based on self-reports, including solid fuel (coal, crop residue, or wood fuel) and clean fuel (central heating, solar power, natural gas, liquefied petroleum gas, electricity, or marsh gas). Nonfatal CVD was defined as self-reported physician-diagnosed nonfatal CVD. We established Cox proportional hazard regression models with age as the time scale and strata by sex to evaluate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). RESULTS After a median follow-up of five years, 970 (11.02 %) nonfatal CVD cases were documented, including 423 (9.96 %) in males and 547 (12.01 %) in females. Participants with exposure to solid fuel for cooking and clean fuel for heating [HR (95 % CI):2.01 (1.36-2.96)], solid fuel for heating and clean fuel for cooking [HR (95 % CI):1.45 (1.06-1.99)], and solid fuel for both heating and cooking [HR (95 % CI):1.43 (1.07-1.92)] had an elevated nonfatal CVD risk compared to users of cleaner fuel for both cooking and heating. Those whom self-reported switching from solid fuels to cleaner fuels for cooking had significantly decreased nonfatal CVD risk [HR (95 % CI):0.76 (0.58-0.99)] than participants who did not switch to cleaner fuels. CONCLUSIONS Exposure to domestic solid fuel burning for cooking or heating is associated with an elevated nonfatal CVD risk. Notably, switching cooking fuels from solid to cleaner fuels is related to a reduced risk of nonfatal CVD.
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Affiliation(s)
- Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Ning Ning
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Ting Sun
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Hongcai Guan
- School of Public Health, Peking University, Beijing, China
| | - Zuyun Liu
- School of Public Health and the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Wanshui Yang
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China.
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5
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Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, McCracken JP, Davila-Roman V, Fuentes LDL, Quinn AK, Clark M, Diaz A, Pillarisetti A, Steenland K, Waller LA, Jabbarzadeh S, Peel JL, Checkley W. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. ENVIRONMENTAL RESEARCH 2022; 214:114121. [PMID: 36029836 PMCID: PMC9492861 DOI: 10.1016/j.envres.2022.114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 06/18/2023]
Abstract
Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9-139.5 μg/m3, BC was 6.4-16.1 μg/m3, and CO was 0.5-2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0-20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8-10.5) and 9.2 mm Hg (95% CI 3.3-15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.
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Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Lindsay Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Suzanne Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, USA
| | - Gurusamy Thangavel
- Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, UK
| | - John P McCracken
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala; Global Health Institute, Epidemiology and Biostatistics Department, University of Georgia, Athens, GA, USA
| | | | | | - Ashlinn K Quinn
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Maggie Clark
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Anaite Diaz
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala
| | - Ajay Pillarisetti
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
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Wagner DN, Odhiambo SR, Ayikukwei RM, Boor BE. High time-resolution measurements of ultrafine and fine woodsmoke aerosol number and surface area concentrations in biomass burning kitchens: A case study in Western Kenya. INDOOR AIR 2022; 32:e13132. [PMID: 36305061 PMCID: PMC9828051 DOI: 10.1111/ina.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Indoor air pollution associated with biomass combustion for cooking remains a significant environmental health challenge in rural regions of sub-Saharan Africa; however, routine monitoring of woodsmoke aerosol concentrations continues to remain sparse. There is a paucity of field data on concentrations of combustion-generated ultrafine particles, which efficiently deposit in the human respiratory system, in such environments. Field measurements of ultrafine and fine woodsmoke aerosol (diameter range: 10-2500 nm) with field-portable diffusion chargers were conducted across nine wood-burning kitchens in Nandi County, Kenya. High time-resolution measurements (1 Hz) revealed that indoor particle number (PN) and particle surface area (PSA) concentrations of ultrafine and fine woodsmoke aerosol are strongly temporally variant, reach exceedingly high levels (PN > 106 /cm3 ; PSA > 104 μm2 /cm3 ) that are seldom observed in non-biomass burning environments, are influenced by kitchen architectural features, and are moderately to poorly correlated with carbon monoxide concentrations. In five kitchens, PN concentrations remained above 105 /cm3 for more than half of the day due to frequent cooking episodes. Indoor/outdoor ratios of PN and PSA concentrations were greater than 10 in most kitchens and exceeded 100 in several kitchens. Notably, the use of metal chimneys significantly reduced indoor PN and PSA concentrations.
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Affiliation(s)
- Danielle N. Wagner
- Lyles School of Civil Engineering, Purdue UniversityWest LafayetteIndianaUSA
- Ray W. Herrick Laboratories, Center for High Performance BuildingsPurdue UniversityWest LafayetteIndianaUSA
| | | | | | - Brandon E. Boor
- Lyles School of Civil Engineering, Purdue UniversityWest LafayetteIndianaUSA
- Ray W. Herrick Laboratories, Center for High Performance BuildingsPurdue UniversityWest LafayetteIndianaUSA
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7
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Ye W, Steenland K, Quinn A, Liao J, Balakrishnan K, Rosa G, Ndagijimana F, Ntivuguruzwa JDD, Thompson LM, McCracken JP, Díaz-Artiga A, Rosenthal JP, Papageorghiou A, Davila-Roman VG, Pillarisetti A, Johnson M, Wang J, Nicolaou L, Checkley W, Peel JL, Clasen TF. Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial. Hypertension 2022; 79:1887-1898. [PMID: 35708015 PMCID: PMC9278708 DOI: 10.1161/hypertensionaha.122.19362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies. METHODS We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP. RESULTS Median 24-hour PM2.5 dropped from 84 to 24 μg/m3 after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03-1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05-1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance. CONCLUSIONS In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley (W.Y., A. Pillarisetti)
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, CA (A.Q., M.J.)
| | - Jiawen Liao
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles (J.L.)
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India (K.B.)
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom (G.R.)
| | | | | | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta, GA
| | - John P. McCracken
- Department of Environmental Health Sciences, University of Georgia, Athens (J.P.M.)
| | | | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD (J.P.R.)
| | - Aris Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, United Kingdom (A. Papageorghiou)
| | | | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley (W.Y., A. Pillarisetti)
| | | | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health (J.W.), Emory University, Atlanta, GA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine (L.N., W.C.), Johns Hopkins University, Baltimore, MD
- Center for Global Non-Communicable Disease Research and Training (L.N., W.C.), Johns Hopkins University, Baltimore, MD
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine (L.N., W.C.), Johns Hopkins University, Baltimore, MD
- Center for Global Non-Communicable Disease Research and Training (L.N., W.C.), Johns Hopkins University, Baltimore, MD
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
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8
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Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. ENVIRONMENTAL RESEARCH 2022; 208:112756. [PMID: 35065931 PMCID: PMC8935388 DOI: 10.1016/j.envres.2022.112756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing multi-center randomized controlled trial assessing the impact of a liquified petroleum gas (LPG) cookstove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from burning solid fuels on cardiovascular health during pregnancy, we sought to determine whether baseline exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), black carbon (BC) and carbon monoxide (CO) were associated with blood pressure among 799 pregnant women in Tamil Nadu, India, one of the HAPIN trial centers. METHODS Multivariable linear regression models were used to examine the association between 24-h personal exposure to PM2.5/BC/CO and systolic and diastolic blood pressure, controlling for maternal age, body mass index (BMI), mother's education, household wealth, gestational age, and season. At the time of measurement, women were between 9- and 20-weeks of gestation. RESULTS We found that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in pregnant women exposed to higher levels of HAP, though only the result for CO and DBP reached conventional statistical significance (p < 0.05). We observed a positive association between CO and DBP among the entire study cohort: a 1-log μg/m3 increase in CO exposure was associated with 0.36 mmHg higher DBP (95% confidence interval [CI]: 0.02 to 0.70). The effect was stronger in pregnant women with higher CO exposures (in the 3rd [≥ 0.9 and < 2.1 ppm] and 4th quartiles [≥ 2.1 and ≤ 46.9 ppm]). We also found that pregnant women with PM2.5 exposures in the highest quartile (≥ 129.9 and ≤ 2100 μg/m3) had a borderline significant association (p = 0.054) with DBP compared to those who had PM2.5 exposures in the lowest quartile (≥ 9.4 and < 47.7 μg/m3). No evidence of association was observed for BC exposure and blood pressure. CONCLUSION This study contributes to limited evidence regarding the relationship between HAP exposure and blood pressure among women during pregnancy, a critical window for both mother and child's life-course health. Results from this cross-sectional study suggest that exposures to PM2.5 and CO from solid fuel use are associated with higher blood pressure in pregnant women during their first or second trimester.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Shupler M, Hystad P, Birch A, Chu YL, Jeronimo M, Miller-Lionberg D, Gustafson P, Rangarajan S, Mustaha M, Heenan L, Seron P, Lanas F, Cazor F, Jose Oliveros M, Lopez-Jaramillo P, Camacho PA, Otero J, Perez M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Liu Z, Wu S, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M. Multinational prediction of household and personal exposure to fine particulate matter (PM 2.5) in the PURE cohort study. ENVIRONMENT INTERNATIONAL 2022; 159:107021. [PMID: 34915352 DOI: 10.1016/j.envint.2021.107021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. METHODS The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. RESULTS The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 μg/m3 (Chile); 55 μg/m3 (China)) and 12-fold among households primarily cooking with wood (36 μg/m3 (Chile)); 427 μg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). CONCLUSION Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mustaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pamela Seron
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Paul A Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Johnna Otero
- Universidad Militar Nueva Granada, Bogota, Colombia
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Beijing An Zhen Hospital of the Capital University of Medical Sciences, China
| | - Shutong Wu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, HKSAR, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - K G Jayachitra
- St. John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St. John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Government Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Kumar N, Phillip E, Cooper H, Davis M, Langevin J, Clifford M, Stanistreet D. Do improved biomass cookstove interventions improve indoor air quality and blood pressure? A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 290:117997. [PMID: 34450490 DOI: 10.1016/j.envpol.2021.117997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis evaluates the most recent evidence to examine whether use of improved biomass cookstoves in households in low-middle income countries results in reduction in mean concentrations of carbon monoxide (CO) and particulate matter of size 2.5 μm (PM2.5) in the cooking area, as well as reduction in mean systolic (SBP) and diastolic blood pressure (DBP) of adults using the cookstoves when compared to adults who use traditional three stone fire or traditional biomass cookstoves. METHODS We searched databases of scientific and grey literature. We included studies if published between January 2012 and June 2021, reported impact of ICS interventions in non-pregnant adults in low/middle-income countries, and reported post-intervention results along with baseline of traditional cookstoves. Outcomes included 24- or 48-h averages of kitchen area PM2.5, CO, mean SBP and DBP. Meta-analyses estimated weighted mean differences between baseline and post-intervention values for all outcome measures. RESULTS Eleven studies were included; ten contributed estimates for HAP and four for BP. Interventions lead to significant reductions in PM2.5 (-0.73 mg/m3, 95% CI: -1.33, -0.13), CO (-8.37 ppm, 95%CI: -13.20, -3.54) and SBP (-2.82 mmHg, 95% CI: -5.53, -0.11); and a non-significant reduction in DBP (-0.80 mmHg, 95%CI: -2.33, 0.73), when compared to baseline of traditional cookstoves. Except for DBP, greatest reductions in all outcomes came from standard combustion ICS with a chimney, compared to ICS without a chimney and advanced combustion ICS. CONCLUSION Among the reviewed biomass stove types, ICS with a chimney feature resulted in greatest reductions in HAP and BP.
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Affiliation(s)
- Nitya Kumar
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Manama, Bahrain.
| | - Eunice Phillip
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen Cooper
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Manama, Bahrain
| | - Megan Davis
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jessica Langevin
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mike Clifford
- Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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11
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Quinn AK, Adjei IA, Ae-Ngibise KA, Agyei O, Boamah-Kaali EA, Burkart K, Carrión D, Chillrud SN, Gould CF, Gyaase S, Jack DW, Kaali S, Kinney PL, Lee AG, Mujtaba MN, Oppong FB, Owusu-Agyei S, Yawson A, Wylie BJ, Asante KP. Prenatal household air pollutant exposure is associated with reduced size and gestational age at birth among a cohort of Ghanaian infants. ENVIRONMENT INTERNATIONAL 2021; 155:106659. [PMID: 34134048 PMCID: PMC8628363 DOI: 10.1016/j.envint.2021.106659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Low birth weight and prematurity are important risk factors for death and disability, and may be affected by prenatal exposure to household air pollution (HAP). METHODS We investigate associations between maternal exposure to carbon monoxide (CO) during pregnancy and birth outcomes (birth weight, birth length, head circumference, gestational age, low birth weight, small for gestational age, and preterm birth) among 1288 live-born infants in the Ghana Randomized Air Pollution and Health Study (GRAPHS). We evaluate whether evidence of malaria during pregnancy, as determined by placental histopathology, modifies these associations. RESULTS We observed effects of CO on birth weight, birth length, and gestational age that were modified by placental malarial status. Among infants from pregnancies without evidence of placental malaria, each 1 ppm increase in CO was associated with reduced birth weight (-53.4 g [95% CI: -84.8, -21.9 g]), birth length (-0.3 cm [-0.6, -0.1 cm]), gestational age (-1.0 days [-1.8, -0.2 days]), and weight-for-age Z score (-0.08 standard deviations [-0.16, -0.01 standard deviations]). These associations were not observed in pregnancies with evidence of placental malaria. Each 1 ppm increase in maternal exposure to CO was associated with elevated odds of low birth weight (LBW, OR 1.14 [0.97, 1.33]) and small for gestational age (SGA, OR 1.14 [0.98, 1.32]) among all infants. CONCLUSIONS Even modest reductions in exposure to HAP among pregnant women could yield substantial public health benefits, underscoring a need for interventions to effectively reduce exposure. Adverse associations with HAP were discernible only among those without evidence of placental malaria, a key driver of impaired fetal growth in this malaria-endemic area.
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Affiliation(s)
- Ashlinn K Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Oscar Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | - Daniel Carrión
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven N Chillrud
- Mailman School of Public Health, Columbia University, New York, NY, USA; Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - Carlos F Gould
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | - Alison G Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana; Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Abena Yawson
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Blair J Wylie
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
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12
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Wu CM, Adetona O, Song C. Acute cardiovascular responses of wildland firefighters to working at prescribed burn. Int J Hyg Environ Health 2021; 237:113827. [PMID: 34403889 DOI: 10.1016/j.ijheh.2021.113827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Wildland firefighters at prescribed burns are exposed to elevated levels of wildland fire smoke (WFS) while performing physically demanding tasks. WFS exposure has been linked to increases in hospital and emergency admissions for cardiovascular disorders in the general population. However, knowledge about the cardiovascular effect of occupational WFS exposure among wildland firefighters is limited. To provide a better understanding of the effect of this exposure scenario on acute hemodynamic responses, resting systolic/diastolic blood pressure (SBP/DBP) and heart rate (HR) of wildland firefighters were measured before (pre-shift), after (post-shift), and the morning (next morning) immediately following prescribed burn shifts (burn days) and regular work shifts (non-burn days). A total of 38 firefighters (34 males and 4 females) participated in this study and resting BP and HR were recorded on 9 burn days and 7 non-burn days. On burn days, HR significantly increased from pre-to post-shift (13.25 bpm, 95% CI: 7.47 to 19.02 bpm) while SBP significantly decreased in the morning following the prescribed burns compared to pre-shift (-6.25 mmHg, 95% CI: -12.30 to -0.20 mmHg). However, this was due to the decrease of SBP in the firefighters who were hypertensive (-8.46 mmHg, 95% CI: -16.08 to -0.84 mmHg). Significant cross-shift reductions (post-shift/next morning vs. pre-shift) were observed in SBP on burn days compared to non-burn days (-7.01 mmHg, 95% CI: -10.94 to -3.09 mmHg and -8.64 mmHg, 95% CI: -13.81 to -3.47 mmHg, respectively). A significant reduction on burn days was also observed from pre-shift to the following morning for HR compared to non-burn days (-7.28 bpm, 95% CI: -13.50 to -1.06 bpm) while HR significantly increased in pre-to post-shift on burn days compared to non-burn days (10.61 bpm, 95% CI: 5.05 to 16.17 bpm). The decreased BP observed in wildland firefighters might be due to a high level of carbon monoxide exposure and exercise-induced hypotension. The increase in HR immediately after prescribed burns might be attributable to WFS exposure and physical exertion in prescribed burn shifts. The results suggest that wildland firefighting exposure might cause a distinct hemodynamic response, including SBP reduction and HR increment, especially for those who have pre-existing hypertension.
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Affiliation(s)
- Chieh-Ming Wu
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Chi Song
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
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Checkley W, Williams KN, Kephart JL, Fandiño-Del-Rio M, Steenland NK, Gonzales GF, Naeher LP, Harvey SA, Moulton LH, Davila-Roman VG, Goodman D, Tarazona-Meza C, Miele CH, Simkovich S, Chiang M, Chartier RT, Koehler K. Effects of a Household Air Pollution Intervention with Liquefied Petroleum Gas on Cardiopulmonary Outcomes in Peru. A Randomized Controlled Trial. Am J Respir Crit Care Med 2021; 203:1386-1397. [PMID: 33306939 DOI: 10.1164/rccm.202006-2319oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels. Objectives: We sought to determine if a household air pollution intervention with liquefied petroleum gas (LPG) improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru. Methods: We conducted a randomized controlled field trial in 180 women aged 25-64 years living in rural Puno, Peru. Intervention women received an LPG stove, continuous fuel delivery for 1 year, education, and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households. Measurements and Main Results: We measured blood pressure, peak expiratory flow (PEF), and respiratory symptoms using the St. George's Respiratory Questionnaire at baseline and at 3-4 visits after randomization. Intervention women used their LPG stove exclusively for 98% of days. We did not find differences in average postrandomization systolic blood pressure (intervention - control 0.7 mm Hg; 95% confidence interval, -2.1 to 3.4), diastolic blood pressure (0.3 mm Hg; -1.5 to 2.0), prebronchodilator peak expiratory flow/height2 (0.14 L/s/m2; -0.02 to 0.29), postbronchodilator peak expiratory flow/height2 (0.11 L/s/m2; -0.05 to 0.27), or St. George's Respiratory Questionnaire total score (-1.4; -3.9 to 1.2) over 1 year in intention-to-treat analysis. There were no reported harms related to the intervention. Conclusions: We did not find evidence of a difference in blood pressure, lung function, or respiratory symptoms during the year-long intervention with LPG. Clinical trial registered with www.clinicaltrials.gov (NCT02994680).
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kendra N Williams
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Environmental Health and Engineering
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Environmental Health and Engineering
| | - N Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gustavo F Gonzales
- Department of Biological and Physiological Sciences and.,Laboratory for Research and Development, School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia
| | - Steven A Harvey
- Department of International Health, Program in Social Behavioral Interventions, and
| | - Lawrence H Moulton
- Department of International Health, Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Victor G Davila-Roman
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Cardiovascular Imaging and Clinical Research Core Lab, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Dina Goodman
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Carla Tarazona-Meza
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Biomedical Research Unit, PRISMA, Lima, Peru; and
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Suzanne Simkovich
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Kirsten Koehler
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Environmental Health and Engineering
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14
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Dillon DT, Webster GD, Bisesi JH. Contributions of biomass/solid fuel burning to blood pressure modification in women: A systematic review and meta-analysis. Am J Hum Biol 2021; 34:e23586. [PMID: 33645874 DOI: 10.1002/ajhb.23586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Approximately 2½ billion people worldwide rely on solid/biomass fuel as fuel for cooking/heating the home. Environmental exposure to the smoke associated with biomass fuel burning has been associated respiratory diseases, cardiac disorders, and altered blood pressure. Therefore, a systematic review and meta-analysis was conducted to study this relationship across multiple studies. METHODS Searches were performed using PRISMA guidelines for articles using Web of Science, PubMed, Toxline, and Web of Science of peer reviewed papers with no beginning time restriction until February 2017. The search yielded 10 manuscripts after application of inclusion criteria, which encompassed 93 724 participants. Outcomes included (a) the proportion of people with a clinical diagnosis of hypertension in an exposed (vs. unexposed) population or (b) correlation coefficients examining degree of exposure and systolic/diastolic blood pressure. RESULTS The four studies reporting effect sizes for hypertension (N = 92 042) had a weighted mean effect size of r = .12 [-0.02, 0.27], z = 1.66, p = 0.097. The six studies reporting effect sizes for systolic and diastolic blood pressure (N = 1682) had weighted mean effect sizes of r = .15 [0.06, 0.24], p = 0.001, and r = .09 [0.03, 0.15], p = 0.002, respectively. CONCLUSION These analyses revealed that there is a small-but-significant relationship between biomass fuel exposure and an increase in both systolic and diastolic blood pressure, but the relationship between biomass fuel and hypertension specifically remains unclear.
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Affiliation(s)
- David T Dillon
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
| | - Gregory D Webster
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Joseph H Bisesi
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, USA
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15
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Chen H, Samet JM, Bromberg PA, Tong H. Cardiovascular health impacts of wildfire smoke exposure. Part Fibre Toxicol 2021; 18:2. [PMID: 33413506 PMCID: PMC7791832 DOI: 10.1186/s12989-020-00394-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, wildland fires have occurred more frequently and with increased intensity in many fire-prone areas. In addition to the direct life and economic losses attributable to wildfires, the emitted smoke is a major contributor to ambient air pollution, leading to significant public health impacts. Wildfire smoke is a complex mixture of particulate matter (PM), gases such as carbon monoxide, nitrogen oxide, and volatile and semi-volatile organic compounds. PM from wildfire smoke has a high content of elemental carbon and organic carbon, with lesser amounts of metal compounds. Epidemiological studies have consistently found an association between exposure to wildfire smoke (typically monitored as the PM concentration) and increased respiratory morbidity and mortality. However, previous reviews of the health effects of wildfire smoke exposure have not established a conclusive link between wildfire smoke exposure and adverse cardiovascular effects. In this review, we systematically evaluate published epidemiological observations, controlled clinical exposure studies, and toxicological studies focusing on evidence of wildfire smoke exposure and cardiovascular effects, and identify knowledge gaps. Improving exposure assessment and identifying sensitive cardiovascular endpoints will serve to better understand the association between exposure to wildfire smoke and cardiovascular effects and the mechanisms involved. Similarly, filling the knowledge gaps identified in this review will better define adverse cardiovascular health effects of exposure to wildfire smoke, thus informing risk assessments and potentially leading to the development of targeted interventional strategies to mitigate the health impacts of wildfire smoke.
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Affiliation(s)
- Hao Chen
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830, USA.
| | - James M Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Chapel Hill, NC, 27514, USA
| | - Philip A Bromberg
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Haiyan Tong
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Chapel Hill, NC, 27514, USA.
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16
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Cole-Hunter T, Dhingra R, Fedak KM, Good N, L'Orange C, Luckasen G, Mehaffy J, Walker E, Wilson A, Balmes J, Brook RD, Clark ML, Devlin RB, Volckens J, Peel JL. Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study. ENVIRONMENT INTERNATIONAL 2021; 146:106254. [PMID: 33221594 PMCID: PMC7775898 DOI: 10.1016/j.envint.2020.106254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. OBJECTIVES To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. METHODS Forty-eight healthy adults (46% female; 20-36 years) participated in six, 2-h exposures ('treatments'), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. RESULTS Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = -0.13 ms {%}; 95% confidence interval = -0.22, -0.03%), which reversed in direction at 3 h (0.03%; -0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. DISCUSSION We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.
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Affiliation(s)
- Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW, Australia; International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, University of North Carolina, NC, USA; Environmental Public Health Division, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Kristen M Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ethan Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert B Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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17
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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18
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Bellows AL, Spiegelman D, Du S, Jaacks LM. The Association of Cooking Fuel Use, Dietary Intake, and Blood Pressure among Rural Women in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155516. [PMID: 32751678 PMCID: PMC7432946 DOI: 10.3390/ijerph17155516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 01/04/2023]
Abstract
Household air pollution (HAP) from solid cooking fuels continues to affect 600 million people in China and has been associated with high blood pressure. The role of diet in HAP-associated high blood pressure has yet to be evaluated in China. The aim of this study was to estimate the impact of cooking fuel on change in blood pressure and evaluate whether intake of antioxidant- and omega-3 fatty acid-rich foods (fruits, vegetables, and seafood) attenuates any adverse effects of solid fuel use on blood pressure. We analyzed longitudinal data collected between 1991 and 2011 from nonpregnant women aged 18 to 80 years living in rural areas of China. We used linear mixed effects models to estimate the association between cooking fuel (coal or wood versus clean [electric or liquid petroleum gas]) and blood pressure. Possible mediation of the fuel effect by diet was assessed by the difference method. A total of 6671 women were included in this study. Women less than 40 years of age cooking with cleaner fuels over time had lower rates of change in systolic blood pressure compared to women cooking with coal (p = 0.004), and this effect was not mediated by dietary intake. Associations between fuel use and change in diastolic blood pressure were not significant. These findings lend further support for there being a direct effect of reducing HAP on improvements in blood pressure, independent of concurrent dietary intake.
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Affiliation(s)
- Alexandra L. Bellows
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Donna Spiegelman
- Center for Methods on Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06520, USA;
| | - Shufa Du
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Edinburgh EH25 9RG, UK
- Correspondence:
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19
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Pratiti R, Vadala D, Kalynych Z, Sud P. Health effects of household air pollution related to biomass cook stoves in resource limited countries and its mitigation by improved cookstoves. ENVIRONMENTAL RESEARCH 2020; 186:109574. [PMID: 32668541 DOI: 10.1016/j.envres.2020.109574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Household air pollution (HAP) related to cooking is associated with significant global morbidity and mortality. An estimated three billion people worldwide are exposed to cooking related HAP caused by solid fuel combustion. This exposure is highest for the vulnerable population of women and children resulting in significant cumulative health effects. METHODS A literature review was conducted for health effects of household air pollution related to biomass cookstoves in resource limited countries and to evaluate the effect of improved cookstoves on these health effects. We searched PubMed, Embase and Cochrane Library. We conducted searches in January 2018 with a repeat in February 2020. We included only studies conducted in resource limited countries, published in English, irrespective of publication year and studies that examined the health effects of HAP and/or studied the effects of improved cookstove (IC). Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search term: biomass cookstoves and health risks. We also assessed the limitations of IC with barriers to their uptake. RESULTS Health effects associated with HAP mostly include increased blood pressure (BP), dyspnea, childhood pneumonia, lung cancer, low birthweight and cardiovascular diseases. Being a global problem with divergent environmental factors including wide variety of fuel used, housing condition, foods prepared, climatic condition and social factors; most solutions though efficient seems inadequate. Improved cookstove (IC) mitigates emissions and improves short term health, though few randomized long-term studies could substantiate its long-standing continuance and health benefits. CONCLUSION There is ample data about the health effects of HAP, with some benefit with IC intervention for elevated blood pressure, dyspnea symptoms, mutagenicity and cardiovascular diseases. IC does not have any benefit in pregnancy outcomes or children health.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA.
| | - David Vadala
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Zirka Kalynych
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Parul Sud
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
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20
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Walker ES, Clark ML, Young BN, Rajkumar S, Benka-Coker ML, Bachand AM, Brook RD, Nelson TL, Volckens J, Reynolds SJ, L’Orange C, Africano S, Pinel ABO, Good N, Koehler K, Peel JL. Exposure to household air pollution from biomass cookstoves and self-reported symptoms among women in rural Honduras. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:160-173. [PMID: 30760020 PMCID: PMC6692243 DOI: 10.1080/09603123.2019.1579304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
Household air pollution from combustion of solid fuels is an important risk factor for morbidity and mortality, causing an estimated 2.6 million premature deaths globally in 2016. Self-reported health symptoms are a meaningful measure of quality of life, however, few studies have evaluated symptoms and quantitative measures of exposure to household air pollution. We assessed the cross-sectional association of self-reported symptoms and exposures to household air pollution among women in rural Honduras using stove type (traditional [n = 76]; cleaner-burning Justa [n = 74]) and 24-hour average personal and kitchen fine particulate matter (PM2.5) concentrations. The odds of prevalent symptoms were higher among women using traditional stoves vs Justa stoves (e.g. headache: odds ratio = 2.23; 95% confidence interval = 1.13-4.39). Associations between symptoms and measured PM2.5 were generally consistent with the null. These results add to the evidence suggesting reduced exposures and better health-related quality of life among women using cleaner-burning biomass stoves.
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Affiliation(s)
- Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Bonnie N. Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Megan L. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Annette M. Bachand
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science and Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Stephen J. Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Mountain and Plains ERC, Denver, CO, USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | | | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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21
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Clark SN, Schmidt AM, Carter EM, Schauer JJ, Yang X, Ezzati M, Daskalopoulou SS, Baumgartner J. Longitudinal evaluation of a household energy package on blood pressure, central hemodynamics, and arterial stiffness in China. ENVIRONMENTAL RESEARCH 2019; 177:108592. [PMID: 31351323 DOI: 10.1016/j.envres.2019.108592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/15/2019] [Accepted: 07/15/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cardiovascular diseases are the leading contributors to disease burden in China and globally, and household air pollution exposure is associated with risk of cardiovascular disease. OBJECTIVES We evaluated whether subclinical cardiovascular outcomes in adult Chinese women would improve after distribution of an energy package comprised of a semi-gasifier cookstove, water heater, chimney, and supply of processed biomass fuel. METHODS We enrolled 204 households (n = 205 women) from 12 villages into a controlled before- and after-intervention study on cardiovascular health and air pollution in Sichuan Province. The intervention was distributed to 124 households during a government-sponsored rural energy demonstration program. The remaining 80 households received the package 18 months later at the end of the study, forming a comparison group. One woman from each household had their blood pressure (BP), central hemodynamics, and arterial stiffness measured along with exposures to air pollution and demographic and household characteristics, on up to five visits. We used a difference-in-differences mixed-effects regression approach with Bayesian inference to assess the impact of the energy package on sub-clinical cardiovascular outcomes. RESULTS Women who did not receive the energy package had greater mean decreases in brachial systolic (-4.1 mmHg, 95% credible interval (95%CIe) -7.3, -0.9) and diastolic BP (-2.0 mmHg, 95%CIe -3.6, -0.5) compared with women who received the package (systolic: -2.7, 95%CIe -5.0, -0.4; diastolic: -0.3, 95%CIe -1.4, 0.8) resulting in slightly positive but not statistically significant difference-in-differences effect estimates of 1.3 mmHg (95%CIe -2.5, 5.2) and 1.7 mmHg (95%CIe -0.3, 3.6), respectively. Similar trends were found for central BP, central pulse pressure, and arterial stiffness. Air pollution exposures decreased on average for both treatment groups, with a greater range of reductions among women who did not receive the package (with package: -30% to -50%; without package: +2% to -69%), likely as a result of increased use of gas fuel and electric stoves among this group. Outdoor air quality changed very little over time. CONCLUSIONS Gasifier stoves have been widely promoted as the next generation of 'clean-cooking' technologies, however their effectiveness in improving health in real-world settings should be carefully evaluated and communicated before scaling up their implementation.
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Affiliation(s)
- Sierra N Clark
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Ellison M Carter
- Institute on the Environment, University of Minnesota, Minneapolis, USA; Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, USA
| | - James J Schauer
- Department of Civil and Environmental Engineering, University of Wisconsin, Madison, USA; Environmental Chemistry & Technology Program, University of Wisconsin, Madison, USA
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Majid Ezzati
- School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment and Health, Imperial College London, UK
| | - Stella S Daskalopoulou
- Department of Medicine, Division of Internal Medicine, McGill University, Montreal, Canada
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada; Institute on the Environment, University of Minnesota, Minneapolis, USA.
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22
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Fedak KM, Good N, Walker ES, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Devlin R, L'Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute Effects on Blood Pressure Following Controlled Exposure to Cookstove Air Pollution in the STOVES Study. J Am Heart Assoc 2019; 8:e012246. [PMID: 31286826 PMCID: PMC6662148 DOI: 10.1161/jaha.119.012246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Exposure to air pollution from solid fuel used in residential cookstoves is considered a leading environmental risk factor for disease globally, but evidence for this relationship is largely extrapolated from literature on smoking, secondhand smoke, and ambient fine particulate matter (PM2.5). Methods and Results We conducted a controlled human‐exposure study (STOVES [the Subclinical Tests on Volunteers Exposed to Smoke] Study) to investigate acute responses in blood pressure following exposure to air pollution emissions from cookstove technologies. Forty‐eight healthy adults received 2‐hour exposures to 5 cookstove treatments (three stone fire, rocket elbow, fan rocket elbow, gasifier, and liquefied petroleum gas), spanning PM2.5 concentrations from 10 to 500 μg/m3, and a filtered air control (0 μg/m3). Thirty minutes after exposure, systolic pressure was lower for the three stone fire treatment (500 μg/m3PM2.5) compared with the control (−2.3 mm Hg; 95% CI, −4.5 to −0.1) and suggestively lower for the gasifier (35 μg/m3PM2.5; −1.8 mm Hg; 95% CI, −4.0 to 0.4). No differences were observed at 3 hours after exposure; however, at 24 hours after exposure, mean systolic pressure was 2 to 3 mm Hg higher for all treatments compared with control except for the rocket elbow stove. No differences were observed in diastolic pressure for any time point or treatment. Conclusions Short‐term exposure to air pollution from cookstoves can elicit an increase in systolic pressure within 24 hours. This response occurred across a range of stove types and PM2.5 concentrations, raising concern that even low‐level exposures to cookstove air pollution may pose adverse cardiovascular effects.
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Affiliation(s)
- Kristen M Fedak
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Nicholas Good
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Ethan S Walker
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - John Balmes
- 2 Department of Medicine University of California San Francisco San Francisco CA
| | - Robert D Brook
- 3 Division of Cardiovascular Medicine University of Michigan Medical School Ann Arbor MI
| | - Maggie L Clark
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Tom Cole-Hunter
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO.,4 Centre for Air Pollution, Energy, and Health Research Queensland University of Technology Brisbane Australia
| | - Robert Devlin
- 5 Environmental Public Health Division United States Environmental Protection Agency Chapel Hill NC
| | - Christian L'Orange
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | | | - John Mehaffy
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | - Rhiannon Shelton
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Ander Wilson
- 8 Department of Statistics Colorado State University Fort Collins CO
| | - John Volckens
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | - Jennifer L Peel
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
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23
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Young BN, Peel JL, Benka-Coker ML, Rajkumar S, Walker ES, Brook RD, Nelson TL, Volckens J, L’Orange C, Good N, Quinn C, Keller JP, Weller ZD, Africano S, Osorto Pinel AB, Clark ML. Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health. BMC Public Health 2019; 19:903. [PMID: 31286921 PMCID: PMC6615088 DOI: 10.1186/s12889-019-7214-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24-59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM2.5) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM2.5 and indicators of cardiometabolic health. DISCUSSION This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02658383 , posted January 18, 2016, field work completed May 2018. Official title, "Community-Based Participatory Research: A Tool to Advance Cookstove Interventions." Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018.
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Affiliation(s)
- Bonnie N. Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Megan L. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
- Department of Health Sciences, Gettysburg College, Gettysburg, PA USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Casey Quinn
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Joshua P. Keller
- Department of Statistics, Colorado State University, Fort Collins, CO USA
| | - Zachary D. Weller
- Department of Statistics, Colorado State University, Fort Collins, CO USA
| | | | - Anibal B. Osorto Pinel
- Trees, Water & People, Fort Collins, CO USA
- Asociación Hondureña para el Desarrollo, Tegucigalpa, Honduras
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
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24
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Onakomaiya D, Gyamfi J, Iwelunmor J, Opeyemi J, Oluwasanmi M, Obiezu-Umeh C, Dalton M, Nwaozuru U, Ojo T, Vieira D, Ogedegbe G, Olopade C. Implementation of clean cookstove interventions and its effects on blood pressure in low-income and middle-income countries: systematic review. BMJ Open 2019; 9:e026517. [PMID: 31092656 PMCID: PMC6530298 DOI: 10.1136/bmjopen-2018-026517] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE A review of the implementation outcomes of clean cookstove use, and its effects on blood pressure (BP) in low-income and middle-income countries (LMICs). DESIGN Systematic review of studies that reported the effect of clean cookstove use on BP among women, and implementation science outcomes in LMICs. DATA SOURCES We searched PubMed, Embase, INSPEC, Scielo, Cochrane Library, Global Health and Web of Science PLUS. We conducted searches in November 2017 with a repeat in May 2018. We did not restrict article publication date. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included only studies conducted in LMICs, published in English, regardless of publication year and studies that examined the use of improved or clean cookstove intervention on BP. Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search terms: high BP, hypertension and or household air pollution, LMICs, cookstove and implementation outcomes. RESULTS Of the 461 non-duplicate articles identified, three randomised controlled trials (RCTs) (in Nigeria, Guatemala and Ghana) and two studies of pre-post design (in Bolivia and Nicaragua) met eligibility criteria. These articles evaluated the effect of cookstove use on BP in women. Two of the three RCTs reported a mean reduction in diastolic BP of -2.8 mm Hg (-5.0, -0.6; p=0.01) for the Nigerian study; -3.0 mm Hg; (-5.7, -0.4; p=0.02) for the Guatemalan study; while the study conducted in Ghana reported a non-significant change in BP. The pre-post studies reported a significant reduction in mean systolic BP of -5.5 mm Hg; (p=0.01) for the Bolivian study, and -5.9 mm Hg (-11.3, -0.4; p=0.05) for the Nicaraguan study. Implementation science outcomes were reported in all five studies (three reported feasibility, one reported adoption and one reported feasibility and adoption of cookstove interventions). CONCLUSION Although this review demonstrated that there is limited evidence on the implementation of clean cookstove use in LMICs, the effects of clean cookstove on BP were significant for both systolic and diastolic BP among women. Future studies should consider standardised reporting of implementation outcomes.
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Affiliation(s)
- Deborah Onakomaiya
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Joyce Gyamfi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Jumoke Opeyemi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Mofetoluwa Oluwasanmi
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Chisom Obiezu-Umeh
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Milena Dalton
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Ucheoma Nwaozuru
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Temitope Ojo
- College of Global Health, New York University, New York City, New York, USA
| | - Dorice Vieira
- College of Global Health, New York University, New York City, New York, USA
- NYU Health Science Library, NYU School of Medicine, New York City, New York, USA
| | - Gbenga Ogedegbe
- Population Health, NYU Langone Health, New York City, New York, USA
| | - Christopher Olopade
- Center for Global Health, University of Chicago, Chicago, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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25
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Jagger P, Das I, Handa S, Nylander-French LA, Yeatts KB. Early Adoption of an Improved Household Energy System in Urban Rwanda. ECOHEALTH 2019; 16:7-20. [PMID: 30617588 PMCID: PMC6592015 DOI: 10.1007/s10393-018-1391-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 10/25/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
Cooking with solid fuels and inefficient cookstoves has adverse consequences for health, environment, and human well-being. Despite the promise of improved cookstoves to reduce these impacts, adoption rates are relatively low. Using a 2-wave sample of 144 households from the baseline and first midline of an ongoing 4-year randomized controlled trial in Rwanda, we analyze the drivers and associations of early adoption of a household energy intervention marketed by a private sector firm. Households sign an annual contract to purchase sustainably produced biomass pellets and lease a fan micro-gasification cookstove with verified emissions reductions in laboratory settings. Using difference-in-differences and fixed effects estimation techniques, we examine the association between take-up of the improved cooking system and household fuel expenditures, health outcomes, and time use for primary cooks. Thirty percent of households adopted the pellet and improved cookstove system. Adopting households had more assets, lower per capita total expenditures and cooking fuel expenditures, and higher per capita hygiene expenditures. Households with married household heads and female cooks were significantly more likely to adopt. Adjusting for confounders, we find significant reduction in primary cooks' systolic blood pressure, self-reported prevalence of shortness of breath, an indicator of respiratory illness, time spent cooking, and household expenditures on charcoal. Our findings have implications for marketing of future clean fuel and improved cookstove programs in urban settings or where stoves and fuel are purchased. Analysis of follow-up surveys will allow for estimation of long-term impacts of adoption of interventions involving pellets and fan micro-gasification cookstoves.
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Affiliation(s)
- Pamela Jagger
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.
- Department of Geography, UNC-CH, Chapel Hill, NC, USA.
| | - Ipsita Das
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Sudhanshu Handa
- Carolina Population Center, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Department of Public Policy, UNC-CH, Chapel Hill, NC, USA
| | - Leena A Nylander-French
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
| | - Karin B Yeatts
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
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26
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Rajkumar S, Young BN, Clark ML, Benka-Coker ML, Bachand AM, Brook RD, Nelson TL, Volckens J, Reynolds SJ, L'Orange C, Good N, Koehler K, Africano S, Osorto Pinel AB, Peel JL. Household air pollution from biomass-burning cookstoves and metabolic syndrome, blood lipid concentrations, and waist circumference in Honduran women: A cross-sectional study. ENVIRONMENTAL RESEARCH 2019; 170:46-55. [PMID: 30557691 PMCID: PMC6360106 DOI: 10.1016/j.envres.2018.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Household air pollution from cooking with solid fuels affects nearly 3 billion people worldwide and is responsible for an estimated 2.5 million premature deaths and 77 million disability-adjusted life years annually. Investigating the effect of household air pollution on indicators of cardiometabolic disease, such as metabolic syndrome, can help clarify the pathways between this widespread exposure and cardiovascular diseases, which are increasing in low- and middle-income countries. METHODS Our cross-sectional study of 150 women in rural Honduras (76 with traditional stoves and 74 with cleaner-burning Justa stoves) explored the effect of household air pollution exposure on cardiovascular disease risk factors. Household air pollution was measured by stove type and 24-h average kitchen and personal fine particulate matter [PM2.5] mass and black carbon concentrations. Health endpoints included non-fasting total cholesterol, high-density lipoprotein, calculated low-density lipoprotein, triglycerides, waist circumference to indicate abdominal obesity, and presence of metabolic syndrome (defined by current modified international guidelines: waist circumference ≥ 80 cm plus any two of the following: triglycerides > 200 mg/dL, HDL < 50 mg/dL, systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 85 mmHg, or glycated hemoglobin > 5.6%). RESULTS Forty percent of women met the criteria for metabolic syndrome. The prevalence ratio [PR] for metabolic syndrome (versus normal) per interquartile range increase in kitchen PM2.5 and kitchen black carbon was 1.16 (95% confidence interval [CI]: 1.01-1.34) per 312 μg/m3 increase in PM2.5, and 1.07 (95% CI: 1.03-1.12) per 73 μg/m3 increase in black carbon. There is suggestive evidence of a stronger effect in women ≥ 40 years of age compared to women < 40 (p-value for interaction = 0.12 for personal PM2.5). There was no evidence of associations between all other exposure metrics and health endpoints. CONCLUSIONS The prevalence of metabolic syndrome among our study population was high compared to global estimates. We observed a suggestive effect between metabolic syndrome and exposure to household air pollution. These results for metabolic syndrome may be driven by specific syndrome components, such as blood pressure. Longitudinal research with repeated health and exposure measures is needed to better understand the link between household air pollution and indicators of cardiometabolic disease risk.
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Affiliation(s)
- Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Bonnie N Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Megan L Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Health Sciences Program, Gettysburg College, Gettysburg, PA, USA.
| | - Annette M Bachand
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Tracy L Nelson
- Department of Health and Exercise Science, Colorado State University; Fort Collins, CO, USA.
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
| | - Stephen J Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Anibal B Osorto Pinel
- Trees, Water & People, Fort Collins, CO, USA; Asociación Hondureña para el Desarrollo, Tegucigalpa, Honduras
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
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27
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Young BN, Clark ML, Rajkumar S, Benka-Coker ML, Bachand A, Brook RD, Nelson TL, Volckens J, Reynolds SJ, L'Orange C, Good N, Koehler K, Africano S, Osorto Pinel AB, Peel JL. Exposure to household air pollution from biomass cookstoves and blood pressure among women in rural Honduras: A cross-sectional study. INDOOR AIR 2019; 29:130-142. [PMID: 30195255 PMCID: PMC6301093 DOI: 10.1111/ina.12507] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/17/2018] [Accepted: 08/26/2018] [Indexed: 05/03/2023]
Abstract
Growing evidence links household air pollution exposure from biomass cookstoves with elevated blood pressure. We assessed cross-sectional associations of 24-hour mean concentrations of personal and kitchen fine particulate matter (PM2.5 ), black carbon (BC), and stove type with blood pressure, adjusting for confounders, among 147 women using traditional or cleaner-burning Justa stoves in Honduras. We investigated effect modification by age and body mass index. Traditional stove users had mean (standard deviation) personal and kitchen 24-hour PM2.5 concentrations of 126 μg/m3 (77) and 360 μg/m3 (374), while Justa stove users' exposures were 66 μg/m3 (38) and 137 μg/m3 (194), respectively. BC concentrations were similarly lower among Justa stove users. Adjusted mean systolic blood pressure was 2.5 mm Hg higher (95% CI, 0.7-4.3) per unit increase in natural log-transformed kitchen PM2.5 concentration; results were stronger among women of 40 years or older (5.2 mm Hg increase, 95% CI, 2.3-8.1). Adjusted odds of borderline high and high blood pressure (categorized) were also elevated (odds ratio = 1.5, 95% CI, 1.0-2.3). Some results included null values and are suggestive. Results suggest that reduced household air pollution, even when concentrations exceed air quality guidelines, may help lower cardiovascular disease risk, particularly among older subgroups.
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Affiliation(s)
- Bonnie N Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Megan L Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
- Health Sciences, Gettysburg College, Gettysburg, Pennsylvania
| | - Annette Bachand
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tracy L Nelson
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Stephen J Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
- Mountain and Plains ERC, Colorado School of Public Health, Aurora, Colorado
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Anibal B Osorto Pinel
- Trees, Water & People, Fort Collins, Colorado
- Asociación Hondureña para el Desarrollo, Tegucigalpa, Honduras
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
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28
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Shupler M, Godwin W, Frostad J, Gustafson P, Arku RE, Brauer M. Global estimation of exposure to fine particulate matter (PM 2.5) from household air pollution. ENVIRONMENT INTERNATIONAL 2018; 120:354-363. [PMID: 30119008 DOI: 10.1016/j.envint.2018.08.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposure to household air pollution (HAP) from cooking with dirty fuels is a leading health risk factor within Asia, Africa and Central/South America. The concentration of particulate matter of diameter ≤ 2.5 μm (PM2.5) is an important metric to evaluate HAP risk, however epidemiological studies have demonstrated significant variation in HAP-PM2.5 concentrations at household, community and country levels. To quantify the global risk due to HAP exposure, novel estimation methods are needed, as financial and resource constraints render it difficult to monitor exposures in all relevant areas. METHODS A Bayesian, hierarchical HAP-PM2.5 global exposure model was developed using kitchen and female HAP-PM2.5 exposure data available in peer-reviewed studies from an updated World Health Organization Global HAP database. Cooking environment characteristics were selected using leave-one-out cross validation to predict quantitative HAP-PM2.5 measurements from 44 studies. Twenty-four hour HAP-PM2.5 kitchen concentrations and male, female and child exposures were estimated for 106 countries in Asia, Africa and Latin America. RESULTS A model incorporating fuel/stove type (traditional wood, improved biomass, coal, dung and gas/electric), urban/rural location, wet/dry season and socio-demographic index resulted in a Bayesian R2 of 0.57. Relative to rural kitchens using gas or electricity, the mean global 24-hour HAP-PM2.5 concentrations were 290 μg/m3 higher (range of regional averages: 110, 880) for traditional stoves, 150 μg/m3 higher (range of regional averages: 50, 290) for improved biomass stoves, 850 μg/m3 higher (range of regional averages: 310, 2600) for animal dung stoves, and 220 μg/m3 higher (range of regional averages: 80, 650) for coal stoves. The modeled global average female/kitchen exposure ratio was 0.40. Average modeled female exposures from cooking with traditional wood stoves were 160 μg/m3 in rural households and 170 μg/m3 in urban households. Average male and child rural area exposures from traditional wood stoves were 120 μg/m3 and 140 μg/m3, respectively; average urban area exposures were identical to average rural exposures among both sub-groups. CONCLUSIONS A Bayesian modeling approach was used to generate unique HAP-PM2.5 kitchen concentrations and personal exposure estimates for all countries, including those with little to no available quantitative HAP-PM2.5 exposure data. The global exposure model incorporating type of fuel-stove combinations can add specificity and reduce exposure misclassification to enable an improved global HAP risk assessment.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William Godwin
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Joseph Frostad
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
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Aung TW, Baumgartner J, Jain G, Sethuraman K, Reynolds C, Marshall JD, Brauer M. Effect on blood pressure and eye health symptoms in a climate-financed randomized cookstove intervention study in rural India. ENVIRONMENTAL RESEARCH 2018; 166:658-667. [PMID: 30015250 DOI: 10.1016/j.envres.2018.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Air pollution from cooking with solid fuels is a potentially modifiable risk factor for increased blood pressure and may lead to eye irritation. OBJECTIVES To evaluate whether a climate motivated cookstove intervention reduced blood pressure and eye irritation symptoms in Indian women. METHODS Households using traditional stoves were randomized to receive a rocket stove or continue using traditional stoves. Systolic (SBP) and diastolic blood pressure (DBP), and self-reported eye symptoms were measured twice, pre-intervention and at least 124 days post-intervention in women > 25 years old in control (N = 111) and intervention (N = 111) groups in rural Karnataka, India. Daily (24-h) fine particle (PM2.5) mass and absorbance (Abs) were measured in cooking areas at each visit. Mixed-effect models were used to estimate before-and-after differences in SBP, DBP and eye symptoms. RESULTS We observed a lower SBP (-2.0 (-4.5, 0.5) mmHg) and DBP (-1.1 (-2.9, 0.6) mmHg) among exclusive users of intervention stove, although confidence intervals included zero. Stacking or mixed use of intervention and traditional stoves contributed to a small increase in SBP 2.6 (-0.4, 5.7) mmHg) and DBP (1.2 (-0.9, 3.3) mmHg). Exclusive and mixed stove users experienced higher post-intervention reductions, on average, in self-reported eye irritation symptoms for burning sensation in eyes, and eyes look red often compared to control. Median air pollutant concentrations increased post-intervention in all stove groups, with the lowest median PM2.5 increase in the exclusive intervention stove group. CONCLUSIONS Health benefits were limited due to stacking and lower-than-predicted efficiency of the intervention stove in the field. Stove adoption and use behavior, in addition to stove technology, affects achievement of health co-benefits. Carbon-financing schemes need to align with international guidelines that have been set based on health outcomes to maximize health co-benefits from cookstove interventions.
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Affiliation(s)
- Ther W Aung
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4.
| | - Jill Baumgartner
- Institute for Health & Social Policy and Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Charles Meredith House, Room B7, Montreal, Quebec, Canada.
| | - Grishma Jain
- Resource Optimization Initiative, No. 66, 1st Cross, Domlur Layout, Bangalore 560071, Karnataka, India.
| | - Karthik Sethuraman
- Resource Optimization Initiative, No. 66, 1st Cross, Domlur Layout, Bangalore 560071, Karnataka, India.
| | - Conor Reynolds
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4.
| | - Julian D Marshall
- Civil and Environmental Engineering, University of Washington, Wilcox 268, Seattle, WA, USA.
| | - Michael Brauer
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3.
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Fedak KM, Good N, Dahlke J, Hecobian A, Sullivan A, Zhou Y, Peel JL, Volckens J. Chemical Composition and Emissions Factors for Cookstove Startup (Ignition) Materials. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:9505-9513. [PMID: 30011986 PMCID: PMC7050414 DOI: 10.1021/acs.est.8b02218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Air pollution from cookstoves creates a substantial human and environmental health burden. A disproportionate fraction of emissions can occur during stove ignition (startup) compared to main cooking, yet startup material emissions are poorly quantified. Laboratory tests were conducted to measure emissions from startups using kerosene, plastic bags, newspaper, fabric, food packaging, rubber tire tubes, kindling, footwear, and wood shims. Measured pollutants included: fine particulate matter mass (PM2.5), PM2.5 elemental and organic carbon, methane, carbon monoxide, carbon dioxide, benzene, and formaldehyde. Results demonstrate substantial variability in the measured emissions across materials on a per-startup basis. For example, kerosene emitted 496 mg PM2.5 and 999 mg CO per startup, whereas plastic bags emitted 2 mg PM2.5 and 30 mg CO. When considering emissions on a per-mass basis, the ordering of materials from highest-to-lowest emissions changes, emphasizing the importance of establishing how much material is needed to start a stove. The proportional contribution of startups to overall emissions varies depending on startup material type, stove type, and cooking event length; however, results demonstrate that startup materials can contribute substantially to a cookstove's emissions. Startup material choice is especially important for cleaner stove-fuel combinations where the marginal benefits of reduced emissions are potentially greater.
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Affiliation(s)
- Kristen M. Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- CORRESPONDING AUTHOR:
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jordyn Dahlke
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Arsineh Hecobian
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado, USA
| | - Amy Sullivan
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado, USA
| | - Yong Zhou
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
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Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, van Schayck OCP, Been JV. Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis. Thorax 2018; 73:1026-1040. [PMID: 29925674 DOI: 10.1136/thoraxjnl-2017-210952] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs). DESIGN Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation. SETTING LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women. RESULTS We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women. CONCLUSION Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact. REGISTRATION PROSPERO: CRD42016033075.
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Affiliation(s)
- Megha Thakur
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Paulien A W Nuyts
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther A Boudewijns
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Flores Kim
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Timor Faber
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Giridhara R Babu
- Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Onno C P van Schayck
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Jasper V Been
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Arku RE, Birch A, Shupler M, Yusuf S, Hystad P, Brauer M. Characterizing exposure to household air pollution within the Prospective Urban Rural Epidemiology (PURE) study. ENVIRONMENT INTERNATIONAL 2018; 114:307-317. [PMID: 29567495 PMCID: PMC5899952 DOI: 10.1016/j.envint.2018.02.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/28/2018] [Accepted: 02/20/2018] [Indexed: 05/11/2023]
Abstract
BACKGROUND Household air pollution (HAP) from combustion of solid fuels is an important contributor to disease burden in low- and middle-income countries (LIC, and MIC). However, current HAP disease burden estimates are based on integrated exposure response curves that are not currently informed by quantitative HAP studies in LIC and MIC. While there is adequate evidence supporting causal relationships between HAP and respiratory disease, large cohort studies specifically examining relationships between quantitative measures of HAP exposure with cardiovascular disease are lacking. OBJECTIVE We aim to improve upon exposure proxies based on fuel type, and to reduce exposure misclassification by quantitatively measuring exposure across varying cooking fuel types and conditions in diverse geographies and socioeconomic settings. We leverage technology advancements to estimate household and personal PM2.5 (particles below 2.5 μm in aerodynamic diameter) exposure within the large (N~250,000) multi-country (N~26) Prospective Urban and Rural Epidemiological (PURE) cohort study. Here, we detail the study protocol and the innovative methodologies being used to characterize HAP exposures, and their application in epidemiologic analyses. METHODS/DESIGN This study characterizes HAP PM2.5 exposures for participants in rural communities in ten PURE countries with >10% solid fuel use at baseline (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, South Africa, Tanzania, and Zimbabwe). PM2.5 monitoring includes 48-h cooking area measurements in 4500 households and simultaneous personal monitoring of male and female pairs from 20% of the selected households. Repeat measurements occur in 20% of households to assess impacts of seasonality. Monitoring began in 2017, and will continue through 2019. The Ultrasonic Personal Aerosol Sampler (UPAS), a novel, robust, and inexpensive filter based monitor that is programmable through a dedicated mobile phone application is used for sampling. Pilot study field evaluation of cooking area measurements indicated high correlation between the UPAS and reference Harvard Impactors (r = 0.91; 95% CI: 0.84, 0.95; slope = 0.95). To facilitate tracking and to minimize contamination and analytical error, the samplers utilize barcoded filters and filter cartridges that are weighed pre- and post-sampling using a fully automated weighing system. Pump flow and pressure measurements, temperature and RH, GPS coordinates and semi-quantitative continuous particle mass concentrations based on filter differential pressure are uploaded to a central server automatically whenever the mobile phone is connected to the internet, with sampled data automatically screened for quality control parameters. A short survey is administered during the 48-h monitoring period. Post-weighed filters are further analyzed to estimate black carbon concentrations through a semi-automated, rapid, cost-effective image analysis approach. The measured PM2.5 data will then be combined with PURE survey information on household characteristics and behaviours collected at baseline and during follow-up to develop quantitative HAP models for PM2.5 exposures for all rural PURE participants (~50,000) and across different cooking fuel types within the 10 index countries. Both the measured (in the subset) and the modelled exposures will be used in separate longitudinal epidemiologic analyses to assess associations with cardiopulmonary mortality, and disease incidence. DISCUSSION The collected data and resulting characterization of cooking area and personal PM2.5 exposures in multiple rural communities from 10 countries will better inform exposure assessment as well as future epidemiologic analyses assessing the relationships between quantitative estimates of chronic HAP exposure with adult mortality and incident cardiovascular and respiratory disease. This will provide refined and more accurate exposure estimates in global CVD related exposure-response analyses.
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Affiliation(s)
- Raphael E Arku
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada; Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
| | - Aaron Birch
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Matthew Shupler
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
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Yu K, Qiu G, Chan KH, Lam KBH, Kurmi OP, Bennett DA, Yu C, Pan A, Lv J, Guo Y, Bian Z, Yang L, Chen Y, Hu FB, Chen Z, Li L, Wu T. Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA 2018; 319:1351-1361. [PMID: 29614179 PMCID: PMC5933384 DOI: 10.1001/jama.2018.2151] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/15/2018] [Indexed: 01/08/2023]
Abstract
Importance When combusted indoors, solid fuels generate a large amount of pollutants such as fine particulate matter. Objective To assess the associations of solid fuel use for cooking and heating with cardiovascular and all-cause mortality. Design, Setting, and Participants This nationwide prospective cohort study recruited participants from 5 rural areas across China between June 2004 and July 2008; mortality follow-up was until January 1, 2014. A total of 271 217 adults without a self-reported history of physician-diagnosed cardiovascular disease at baseline were included, with a random subset (n = 10 892) participating in a resurvey after a mean interval of 2.7 years. Exposures Self-reported primary cooking and heating fuels (solid: coal, wood, or charcoal; clean: gas, electricity, or central heating), switching of fuel type before baseline, and use of ventilated cookstoves. Main Outcomes and Measures Death from cardiovascular and all causes, collected through established death registries. Results Among the 271 217 participants, the mean (SD) age was 51.0 (10.2) years, and 59% (n = 158 914) were women. A total of 66% (n = 179 952) of the participants reported regular cooking (at least weekly) and 60% (n = 163 882) reported winter heating, of whom 84% (n = 150 992) and 90% (n = 147 272) used solid fuels, respectively. There were 15 468 deaths, including 5519 from cardiovascular causes, documented during a mean (SD) of 7.2 (1.4) years of follow-up. Use of solid fuels for cooking was associated with greater risk of cardiovascular mortality (absolute rate difference [ARD] per 100 000 person-years, 135 [95% CI, 77-193]; hazard ratio [HR], 1.20 [95% CI, 1.02-1.41]) and all-cause mortality (ARD, 338 [95% CI, 249-427]; HR, 1.11 [95% CI, 1.03-1.20]). Use of solid fuels for heating was also associated with greater risk of cardiovascular mortality (ARD, 175 [95% CI, 118-231]; HR, 1.29 [95% CI, 1.06-1.55]) and all-cause mortality (ARD, 392 [95% CI, 297-487]; HR, 1.14 [95% CI, 1.03-1.26]). Compared with persistent solid fuel users, participants who reported having previously switched from solid to clean fuels for cooking had a lower risk of cardiovascular mortality (ARD, 138 [95% CI, 71-205]; HR, 0.83 [95% CI, 0.69-0.99]) and all-cause mortality (ARD, 407 [95% CI, 317-497]; HR, 0.87 [95% CI, 0.79-0.95]), while for heating, the ARDs were 193 (95% CI, 128-258) and 492 (95% CI, 383-601), and the HRs were 0.57 (95% CI, 0.42-0.77) and 0.67 (95% CI, 0.57-0.79), respectively. Among solid fuel users, use of ventilated cookstoves was also associated with lower risk of cardiovascular mortality (ARD, 33 [95% CI, -9 to 75]; HR, 0.89 [95% CI, 0.80-0.99]) and all-cause mortality (ARD, 87 [95% CI, 20-153]; HR, 0.91 [95% CI, 0.85-0.96]). Conclusions and Relevance In rural China, solid fuel use for cooking and heating was associated with higher risks of cardiovascular and all-cause mortality. These risks may be lower among those who had previously switched to clean fuels and those who used ventilation.
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Affiliation(s)
- Kuai Yu
- Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaokun Qiu
- Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ka-Hung Chan
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kin-Bong Hubert Lam
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Om P. Kurmi
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - An Pan
- Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- The Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- The Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Frank B. Hu
- Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- The Chinese Academy of Medical Sciences, Beijing, China
| | - Tangchun Wu
- Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang HH, Clasen T. Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention. ENVIRONMENT INTERNATIONAL 2018; 111:71-79. [PMID: 29182949 PMCID: PMC5801118 DOI: 10.1016/j.envint.2017.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3. METHODS Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed. RESULTS Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%-10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2-3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit. CONCLUSIONS An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory U., Atlanta, Georgia.
| | - Ajay Pillarisetti
- Environmental Health Sciences, University of California, Berkeley, United States
| | - Miles Kirby
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Maggie Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Will Checkley
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Howard H Chang
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Thomas Clasen
- Rollins School of Public Health, Emory U., Atlanta, Georgia
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Arku RE, Ezzati M, Baumgartner J, Fink G, Zhou B, Hystad P, Brauer M. Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries. ENVIRONMENTAL RESEARCH 2018; 160:499-505. [PMID: 29107891 DOI: 10.1016/j.envres.2017.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Approximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses. OBJECTIVES Using nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15-49) from ten resource-poor countries. METHODS We obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach. RESULTS Overall, the country-level mean systolic and diastolic BP were 117 (range: 111-127) and 74 (71-83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4-32.9). The prevalence of solid fuel use was 46.0% (range: 4.1-95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]. CONCLUSIONS Cooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents.
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Affiliation(s)
- Raphael E Arku
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health and WHO Collaborating Centre on NCD Surveillance and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Bin Zhou
- MRC-PHE Centre for Environment and Health and WHO Collaborating Centre on NCD Surveillance and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Perry Hystad
- The School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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Kodros JK, Carter E, Brauer M, Volckens J, Bilsback KR, L'Orange C, Johnson M, Pierce JR. Quantifying the Contribution to Uncertainty in Mortality Attributed to Household, Ambient, and Joint Exposure to PM 2.5 From Residential Solid Fuel Use. GEOHEALTH 2018; 2:25-39. [PMID: 32158998 PMCID: PMC7007171 DOI: 10.1002/2017gh000115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/15/2017] [Accepted: 12/01/2017] [Indexed: 05/13/2023]
Abstract
While there have been substantial efforts to quantify the health burden of exposure to PM2.5 from solid fuel use (SFU), the sensitivity of mortality estimates to uncertainties in input parameters has not been quantified. Moreover, previous studies separate mortality from household and ambient air pollution. In this study, we develop a new estimate of mortality attributable to SFU due to the joint exposure from household and ambient PM2.5 pollution and perform a variance-based sensitivity analysis on mortality attributable to SFU. In the joint exposure calculation, we estimate 2.81 (95% confidence interval: 2.48-3.28) million premature deaths in 2015 attributed to PM2.5 from SFU, which is 580,000 (18%) fewer deaths than would be calculated by summing separate household and ambient mortality calculations. Regarding the sources of uncertainties in these estimates, in China, India, and Latin America, we find that 53-56% of the uncertainty in mortality attributable to SFU is due to uncertainty in the percent of the population using solid fuels and 42-50% from the concentration-response function. In sub-Saharan Africa, baseline mortality rate (72%) and the concentration-response function (33%) dominate the uncertainty space. Conversely, the sum of the variance contributed by ambient and household PM2.5 exposure ranges between 15 and 38% across all regions (the percentages do not sum to 100% as some uncertainty is shared between parameters). Our findings suggest that future studies should focus on more precise quantification of solid fuel use and the concentration-response relationship to PM2.5, as well as mortality rates in Africa.
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Affiliation(s)
- J. K. Kodros
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - E. Carter
- Department of Civil and Environmental EngineeringColorado State UniversityFort CollinsCOUSA
| | - M. Brauer
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - J. Volckens
- Department of Mechanical EngineeringColorado State UniversityFort CollinsCOUSA
| | - K. R. Bilsback
- Department of Mechanical EngineeringColorado State UniversityFort CollinsCOUSA
| | - C. L'Orange
- Department of Mechanical EngineeringColorado State UniversityFort CollinsCOUSA
| | - M. Johnson
- Berkeley Air Monitoring GroupBerkeleyCAUSA
| | - J. R. Pierce
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
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Alexander D, Northcross A, Wilson N, Dutta A, Pandya R, Ibigbami T, Adu D, Olamijulo J, Morhason-Bello O, Karrison T, Ojengbede O, Olopade CO. Randomized Controlled Ethanol Cookstove Intervention and Blood Pressure in Pregnant Nigerian Women. Am J Respir Crit Care Med 2017; 195:1629-1639. [PMID: 28081369 DOI: 10.1164/rccm.201606-1177oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Hypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP). OBJECTIVES To investigate the ability of a clean cookstove intervention to lower BP during pregnancy. METHODS We conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects. MEASUREMENTS AND MAIN RESULTS The change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029). CONCLUSIONS To our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution. Clinical trial registered with www.clinicaltrials.gov (NCT02394574).
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Affiliation(s)
| | - Amanda Northcross
- 2 Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Anindita Dutta
- 1 Center for Global Health.,4 Department of Medicine, and
| | | | - Tope Ibigbami
- 6 Healthy Life for All Foundation, Ibadan, Nigeria; and
| | - Damilola Adu
- 6 Healthy Life for All Foundation, Ibadan, Nigeria; and
| | | | | | - Theodore Karrison
- 8 Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Oladosu Ojengbede
- 7 Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
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Quansah R, Semple S, Ochieng CA, Juvekar S, Armah FA, Luginaah I, Emina J. Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2017; 103:73-90. [PMID: 28341576 DOI: 10.1016/j.envint.2017.03.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Cookstove intervention programs have been increasing over the past two (2) decades in Low and Middle Income Countries (LMICs) across the globe. However, there remains uncertainty regarding the effects of these interventions on household air pollution concentrations, personal exposure concentrations and health outcomes. OBJECTIVES The primary objective was to determine if household air pollution (HAP) interventions were associated with improved indoor air quality (IAQ) in households in LMICs. Given the potential impact of HAP interventions on health, a secondary objective was to evaluate the effectiveness of HAP interventions to improve health in populations receiving these interventions. DATA SOURCES OVID Medline, Ovid Embase, SCOPUS and PubMED were searched from their inception until December 2015 with no restrictions on study design. The WHO Global database of household air pollution measurements and Members' archives were also reviewed together with the reference lists of identified reviews and relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION We considered randomized controlled trials, or non-randomized control trials, or before-and-after studies; original studies; studies conducted in a LMIC (based on the United Nations Human Development Report released in March 2013 (World Bank, 2013); interventions that were explicitly aimed at improving IAQ and/or health from solid fuel use; studies published in a peer-reviewed journal or student theses or reports; studies that reported on outcomes which was indicative of IAQ or/and health. There was no restriction on the type of comparator (e.g. household receiving plancha vs. household using traditional cookstove) used in the intervention study. STUDY APPRAISAL AND SYNTHESIS METHODS Five review authors independently used pre-designed data collection forms to extract information from the original studies and assessed risk of bias using the Effective Public Health Practice Project (EPHPP). We computed standardized weighted mean difference (SMD) using random-effects models. Heterogeneity was computed using the Q and I2-statistics. We examined the influence of various characteristics on the study-specific effect estimates by stratifying the analysis by population type, study design, intervention type, and duration of exposure monitoring. The trim and fill method was used to assess the potential impact of missing studies. RESULTS Fifty-five studies met our a priori inclusion criteria and were included in the systematic review. Fifteen studies provided 43 effect estimates for our meta-analysis. The largest improvement in HAP was observed for average particulate matter (PM) (SMD=1.57) concentrations in household kitchens (1.03), followed by daily personal average concentrations of PM (1.18), and carbon monoxide (CO) concentrations in kitchens. With respect to personal PM, significant improvement was observed in studies of children (1.26) and studies monitoring PM for ≥24h (1.32). This observation was also noted in terms of studies of kitchen concentrations of CO. A significant improvement was also observed for kitchen levels of PM in both adult populations (1.56) and in RCT/cohort designs (1.59) involving replacing cookstoves without chimneys. Our findings on health outcomes were inconclusive. LIMITATIONS, CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS We observed high statistical between study variability in the study-specific estimate. Thus, care should be taken in concluding that HAP interventions - as currently designed and implemented - support reductions in the average kitchen and personal levels of PM and CO. Further, there is limited evidence that current stand-alone HAP interventions yield any health benefits. Post-intervention levels of pollutants were generally still greatly in excess of the relevant WHO guideline and thus a need to promote cleaner fuels in LMICs to reduce HAP levels below the WHO guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER The review has been registered with PROSPERO (registration number CRD42014009768).
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Affiliation(s)
- Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Sean Semple
- Respiratory Intervention Group, Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland
| | | | - Sanjar Juvekar
- KEM Hospital Research Centre, Pune, India; INDEPTH Network, Accra, Ghana
| | | | - Isaac Luginaah
- Department of Geography, Western University, Ontario, Canada
| | - Jacques Emina
- INDEPTH Network, Accra, Ghana; Department of Population and Development Studies, University of Kinshasa, Kinshasa, People's Republic of Congo
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Burroughs Peña MS, Rollins A. Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries. Cardiol Clin 2017; 35:71-86. [PMID: 27886791 DOI: 10.1016/j.ccl.2016.09.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.
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Affiliation(s)
- Melissa S Burroughs Peña
- Division of Cardiology, Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, 11th Floor, Room 1180D, San Francisco, CA 94143, USA.
| | - Allman Rollins
- Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Olopade CO, Frank E, Bartlett E, Alexander D, Dutta A, Ibigbami T, Adu D, Olamijulo J, Arinola G, Karrison T, Ojengbede O. Effect of a clean stove intervention on inflammatory biomarkers in pregnant women in Ibadan, Nigeria: A randomized controlled study. ENVIRONMENT INTERNATIONAL 2017; 98:181-190. [PMID: 27839852 DOI: 10.1016/j.envint.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/12/2016] [Accepted: 11/03/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Exposure to household air pollution (HAP) has been linked to systemic inflammation. We determined the impact of transition from traditional firewood/kerosene stove to bioethanol-burning stove on inflammatory biomarkers in pregnant Nigerian women. METHODS Women (n=324), cooking with kerosene/firewood, were recruited during their first trimester of pregnancy from June 2013-October 2015 and were randomly allocated to either control (n=162) or intervention (n=162) group using web-based randomization. Controls continued to use their own firewood/kerosene stove, while intervention participants received bioethanol CleanCook stoves. Serum concentrations of retinol-binding protein (RBP), malondialdehyde (MDA), tumor necrosis factor alpha (TNF)-α, interleukin (IL)-6, and IL-8 were measured by ELISA. RESULTS After excluding 53 women (loss of follow-up, untimely biomarker assessments, incorrect dates of enrollment), data from 271 women were included in analysis. Mean (SD) change in RBP, MDA, TNF-α, IL-6, and IL-8 between baseline and third trimester was -2.16 (4.47), -19.6 (46.4), 3.72 (37.2), 0.51 (14.4), and 13.2 (197), respectively, in intervention and -2.25 (4.30), -24.6 (43.6), 7.17 (32.6), -1.79, (11.4), and 31.3 (296) in control groups. None of these changes differed significantly between the two treatment arms. However, changes from baseline in TNF-α levels were significantly different between intervention and control groups in subset of women (n=99) using firewood before trial (-7.03 [32.9] vs. +12.4 [33.6]; 95% CI for group difference: -35.4 to -3.4, p=0.018). CONCLUSIONS Decrease in TNF-α concentration from baseline to third trimesters in intervention group women could indicate reduced cardiovascular stress and prothrombotic effects from decreased HAP. Our findings suggest that ethanol-burning stoves may mitigate cardiovascular health risks.
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Affiliation(s)
- Christopher O Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6076, Chicago, IL 60637, USA.
| | - Elizabeth Frank
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA
| | - Emily Bartlett
- Pritzker School of Medicine, University of Chicago, 924 East 57th Street, Suite 104, Chicago, IL 60637, USA
| | - Donee Alexander
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA
| | - Anindita Dutta
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6076, Chicago, IL 60637, USA
| | - Tope Ibigbami
- Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria
| | - Damilola Adu
- Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria
| | - John Olamijulo
- Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria
| | - Ganiyu Arinola
- College of Medicine, University College Hospital, Ibadan, Nigeria
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC2000, Chicago, IL 60637, USA
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria
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Adetona O, Reinhardt TE, Domitrovich J, Broyles G, Adetona AM, Kleinman MT, Ottmar RD, Naeher LP. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol 2016; 28:95-139. [PMID: 26915822 DOI: 10.3109/08958378.2016.1145771] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Each year, the general public and wildland firefighters in the US are exposed to smoke from wildland fires. As part of an effort to characterize health risks of breathing this smoke, a review of the literature was conducted using five major databases, including PubMed and MEDLINE Web of Knowledge, to identify smoke components that present the highest hazard potential, the mechanisms of toxicity, review epidemiological studies for health effects and identify the current gap in knowledge on the health impacts of wildland fire smoke exposure. Respiratory events measured in time series studies as incidences of disease-caused mortality, hospital admissions, emergency room visits and symptoms in asthma and chronic obstructive pulmonary disease patients are the health effects that are most commonly associated with community level exposure to wildland fire smoke. A few recent studies have also determined associations between acute wildland fire smoke exposure and cardiovascular health end-points. These cardiopulmonary effects were mostly observed in association with ambient air concentrations of fine particulate matter (PM2.5). However, research on the health effects of this mixture is currently limited. The health effects of acute exposures beyond susceptible populations and the effects of chronic exposures experienced by the wildland firefighter are largely unknown. Longitudinal studies of wildland firefighters during and/or after the firefighting career could help elucidate some of the unknown health impacts of cumulative exposure to wildland fire smoke, establish occupational exposure limits and help determine the types of exposure controls that may be applicable to the occupation.
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Affiliation(s)
- Olorunfemi Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA .,b Division of Environmental Health Sciences , College of Public Health, the Ohio State University , Columbus , OH , USA
| | - Timothy E Reinhardt
- c AMEC Foster Wheeler Environment & Infrastructure, Inc , Seattle , WA , USA
| | - Joe Domitrovich
- d USDA Forest Service, Missoula Technology and Development Center , Missoula , MT , USA
| | - George Broyles
- e SDA Forest Service, San Dimas Technology and Development Center , San Dimas , CA , USA
| | - Anna M Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
| | - Michael T Kleinman
- f Center for Occupational and Environmental Health, University of California , Irvine , CA , USA , and
| | - Roger D Ottmar
- g USDA Forest Service, Pacific Northwest Research Station , Seattle , WA , USA
| | - Luke P Naeher
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
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Ni K, Carter E, Schauer JJ, Ezzati M, Zhang Y, Niu H, Lai AM, Shan M, Wang Y, Yang X, Baumgartner J. Seasonal variation in outdoor, indoor, and personal air pollution exposures of women using wood stoves in the Tibetan Plateau: Baseline assessment for an energy intervention study. ENVIRONMENT INTERNATIONAL 2016; 94:449-457. [PMID: 27316628 DOI: 10.1016/j.envint.2016.05.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 05/20/2023]
Abstract
Cooking and heating with coal and biomass is the main source of household air pollution in China and a leading contributor to disease burden. As part of a baseline assessment for a household energy intervention program, we enrolled 205 adult women cooking with biomass fuels in Sichuan, China and measured their 48-h personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO) in winter and summer. We also measured the indoor 48-h PM2.5 concentrations in their homes and conducted outdoor PM2.5 measurements during 101 (74) days in summer (winter). Indoor concentrations of CO and nitrogen oxides (NO, NO2) were measured over 48-h in a subset of ~80 homes. Women's geometric mean 48-h exposure to PM2.5 was 80μg/m(3) (95% CI: 74, 87) in summer and twice as high in winter (169μg/m(3) (95% CI: 150, 190), with similar seasonal trends for indoor PM2.5 concentrations (winter: 252μg/m(3); 95% CI: 215, 295; summer: 101μg/m(3); 95% CI: 91, 112). We found a moderately strong relationship between indoor PM2.5 and CO (r=0.60, 95% CI: 0.46, 0.72), and a weak correlation between personal PM2.5 and CO (r=0.41, 95% CI: -0.02, 0.71). NO2/NO ratios were higher in summer (range: 0.01 to 0.68) than in winter (range: 0 to 0.11), suggesting outdoor formation of NO2 via reaction of NO with ozone is a more important source of NO2 than biomass combustion indoors. The predictors of women's personal exposure to PM2.5 differed by season. In winter, our results show that primary heating with a low-polluting fuel (i.e., electric stove or wood-charcoal) and more frequent kitchen ventilation could reduce personal PM2.5 exposures. In summer, primary use of a gaseous fuel or electricity for cooking and reducing exposure to outdoor PM2.5 would likely have the greatest impacts on personal PM2.5 exposure.
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Affiliation(s)
- Kun Ni
- Department of Building Science, Tsinghua University, Beijing, China
| | - Ellison Carter
- Institute on the Environment, University of Minnesota, St. Paul, MN, USA
| | - James J Schauer
- Environmental Chemistry and Technology Program, University of Wisconsin, Madison, WI, USA; Department of Civil and Environmental Engineering, University of Wisconsin, Madison, WI, USA
| | - Majid Ezzati
- MRC-PHE Center for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Yuanxun Zhang
- College of Resources and Environment, University of the Chinese Academy of Sciences, Beijing, China
| | - Hongjiang Niu
- Department of Building Science, Tsinghua University, Beijing, China
| | - Alexandra M Lai
- Department of Civil and Environmental Engineering, University of Wisconsin, Madison, WI, USA
| | - Ming Shan
- Department of Building Science, Tsinghua University, Beijing, China
| | - Yuqin Wang
- College of Resources and Environment, University of the Chinese Academy of Sciences, Beijing, China
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China.
| | - Jill Baumgartner
- Institute on the Environment, University of Minnesota, St. Paul, MN, USA; Institute for Health and Social Policy, Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada.
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Aung TW, Jain G, Sethuraman K, Baumgartner J, Reynolds C, Grieshop AP, Marshall JD, Brauer M. Health and Climate-Relevant Pollutant Concentrations from a Carbon-Finance Approved Cookstove Intervention in Rural India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:7228-38. [PMID: 27253693 DOI: 10.1021/acs.est.5b06208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Efforts to introduce more efficient stoves increasingly leverage carbon-finance to scale up dissemination of interventions. We conducted a randomized intervention study to evaluate a Clean Development Mechanism approved stove replacement impact on fuelwood usage, and climate and health-relevant air pollutants. We randomly assigned 187 households to either receive the intervention or to continue using traditional stoves. Measurements of fine particulate matter (PM2.5) and absorbance were conducted in cooking areas, village center and at upwind background site. There were minor and overlapping seasonal differences (post- minus preintervention change) between control and intervention groups for median (95% CI) fuel use (-0.60 (-1.02, -0.22) vs -0.52 (-1.07, 0.00) kg day(-1)), and 24 h absorbance (35 (18, 60) vs 36 (22, 50) × 10(-6) m(-1)); for 24 h PM2.5, there was a higher (139 (61,229) vs 73(-6, 156) μg m(-3))) increase in control compared to intervention homes between the two seasons. Forty percent of the intervention homes continued using traditional stoves. For intervention homes, absorbance-to-mass ratios suggest a higher proportion of black carbon in PM2.5 emitted from intervention compared with traditional stoves. Absent of field-based evaluation, stove interventions may be pursued that fail to realize expected carbon reductions or anticipated health and climate cobenefits.
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Affiliation(s)
- Ther W Aung
- Institute for Resources, Environment and Sustainability, The University of British Columbia , 2202 Main Mall, Vancouver, British Columbia Canada V6T 1Z4
| | - Grishma Jain
- Resource Optimization Initiative, No. 66, first Floor, first Cross, Domlur Layout, Bangalore 560 071, India
| | - Karthik Sethuraman
- Resource Optimization Initiative, No. 66, first Floor, first Cross, Domlur Layout, Bangalore 560 071, India
| | - Jill Baumgartner
- Institute on Environment, University of Minnesota , 1954 Buford Ave, St. Paul, Minnesota 55108, United States
| | - Conor Reynolds
- Institute for Resources, Environment and Sustainability, The University of British Columbia , 2202 Main Mall, Vancouver, British Columbia Canada V6T 1Z4
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota , 500 Pillsbury Drive SE, Minneapolis, Minnesota 55455, United States
| | - Andrew P Grieshop
- Department of Civil, Construction and Environmental Engineering, North Carolina State University , 431B Mann Hall, Raleigh, North Carolina 27696-7908, United States
| | - Julian D Marshall
- Institute on Environment, University of Minnesota , 1954 Buford Ave, St. Paul, Minnesota 55108, United States
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota , 500 Pillsbury Drive SE, Minneapolis, Minnesota 55455, United States
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia , 2206 East Mall Vancouver, British Columbia V6T 1Z3, Canada
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Mitter SS, Vedanthan R, Islami F, Pourshams A, Khademi H, Kamangar F, Abnet CC, Dawsey SM, Pharoah PD, Brennan P, Fuster V, Boffetta P, Malekzadeh R. Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study. Circulation 2016; 133:2360-9. [PMID: 27297340 PMCID: PMC4910632 DOI: 10.1161/circulationaha.115.020288] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/09/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality. METHODS AND RESULTS The Golestan Cohort Study in northeastern Iran enrolled 50 045 individuals 40 to 75 years of age between 2004 and 2008 and collected data on lifetime household fuel use and other baseline exposures. Participants were followed up through 2012 with a 99% successful follow-up rate. Cox proportional hazards models were fitted to calculate hazard ratios for associations between pehen (local dung), wood, kerosene/diesel, or natural gas burning for cooking and heating and all-cause and cause-specific mortality, with adjustment for lifetime exposure to each of these fuels and potential confounders. A total of 3073 participants (6%) died during follow-up; 78% of these deaths were attributable to noncommunicable diseases, including cardiovascular, oncological, and respiratory illnesses. Adjusted 10-year hazard ratios from kerosene/diesel burning were 1.06 (95% confidence interval, 1.02-1.10) and 1.11 (95% confidence interval, 1.06-1.17) for all-cause and cardiovascular mortality, respectively. Subtype-specific analyses revealed a significant increase in ischemic heart disease (10-year hazard ratio, 1.14; 95% confidence interval, 1.06-1.21) and a trend toward cerebrovascular accident (10-year hazard ratio, 1.08; 95% confidence interval, 0.99-1.17) mortality. Stratification by sex revealed a potential signal for increased risk for all-cause and cardiovascular disease mortality among women compared with men, with similar risk for ischemic heart disease mortality. CONCLUSIONS Household exposure to high-pollution fuels was associated with increased risk for all-cause and cardiovascular disease mortality. Replicating these results worldwide would support efforts to reduce such exposures.
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Affiliation(s)
- Sumeet S Mitter
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.).
| | - Rajesh Vedanthan
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Farhad Islami
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Akram Pourshams
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Hooman Khademi
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Farin Kamangar
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Christian C Abnet
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Sanford M Dawsey
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Paul D Pharoah
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Paul Brennan
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Valentin Fuster
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Paolo Boffetta
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
| | - Reza Malekzadeh
- From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.)
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Norris C, Goldberg MS, Marshall JD, Valois MF, Pradeep T, Narayanswamy M, Jain G, Sethuraman K, Baumgartner J. A panel study of the acute effects of personal exposure to household air pollution on ambulatory blood pressure in rural Indian women. ENVIRONMENTAL RESEARCH 2016; 147:331-42. [PMID: 26928412 DOI: 10.1016/j.envres.2016.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/31/2016] [Accepted: 02/17/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Almost half the world's population is exposed to household air pollution from biomass and coal combustion. The acute effects of household air pollution on the cardiovascular system are poorly characterized. We conducted a panel study of rural Indian women to assess whether personal exposures to black carbon during cooking were associated with acute changes in blood pressure. METHODS We enrolled 45 women (ages 25-66 years) who cooked with biomass fuels. During cooking sessions in winter and summer, we simultaneously measured their personal real-time exposure to black carbon and conducted ambulatory blood pressure measurements every 10min. We recorded ambient temperature and participants' activities while cooking. We assessed body mass index, socioeconomic status, and salt intake. Multivariate mixed effects regression models with random intercepts were used to estimate the associations between blood pressure and black carbon exposure, e.g., average exposure in the minutes preceding blood pressure measurement, and average exposure over an entire cooking session. RESULTS Women's geometric mean (GM) exposure to black carbon during cooking sessions was lower in winter (GM: 40μg/m(3); 95% CI: 30, 53) than in summer (GM: 56μg/m(3); 95% CI: 42, 76). Interquartile range increases in black carbon were associated with changes in systolic blood pressure from -0.4mm Hg (95% CI: -2.3, 1.5) to 1.9mm Hg (95% CI: -0.8, 4.7), with associations increasing in magnitude as black carbon values were assessed over greater time periods preceding blood pressure measurement. Interquartile range increases in black carbon were associated with small decreases in diastolic blood pressure from -0.9mm Hg (95% CI: -1.7, -0.1) to -0.4mm Hg (95% CI: -1.6, 0.8). Associations of a similar magnitude were estimated for cooking session-averaged values. CONCLUSIONS We found some evidence of an association between exposure to black carbon and acute increases in systolic blood pressure in Indian women cooking with biomass fuels, which may have implications for the development of cardiovascular diseases.
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Affiliation(s)
- Christina Norris
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, QC, Canada; Division of Clinical Epidemiology, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Julian D Marshall
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Marie-France Valois
- Department of Medicine, McGill University, Montreal, QC, Canada; Division of Clinical Epidemiology, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - T Pradeep
- SAMUHA, Kanakagiri, Karnataka, India
| | | | | | | | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.
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Essouma M, Bigna JJR, Noubiap JJN. Household Air Pollution, Intermediate Outcomes, and Major Adverse Cardiovascular Events. J Clin Hypertens (Greenwich) 2015; 18:479-80. [PMID: 26491947 DOI: 10.1111/jch.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mickael Essouma
- Division of Medicine, Sangmelima Referral Hospital, Sangmelima, Cameroon
| | - Jean Joel R Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Yaoundé, Member of International Network of the Pasteur Institutes, Yaoundé, Cameroon
| | - Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Medical Diagnostic Center, Yaoundé, Cameroon
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Baumgartner J, Clark ML. Studies of Household Air Pollution and Subclinical Indicators of Cardiovascular Disease Fill Important Knowledge Gaps. J Clin Hypertens (Greenwich) 2015; 18:481. [DOI: 10.1111/jch.12720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins CO
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Improved stove interventions to reduce household air pollution in low and middle income countries: a descriptive systematic review. BMC Public Health 2015; 15:650. [PMID: 26169364 PMCID: PMC4499941 DOI: 10.1186/s12889-015-2024-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Household air pollution (HAP) resulting from the use of solid fuels presents a major public health hazard. Improved stoves have been offered as a potential tool to reduce exposure to HAP and improve health outcomes. Systematic information on stove interventions is limited. Methods We conducted a systematic review of the current evidence of improved stove interventions aimed at reducing HAP in real life settings. An extensive search of ten databases commenced in April 2014. In addition, we searched clinical trial registers and websites for unpublished studies and grey literature. Studies were included if they reported on an improved stove intervention aimed at reducing HAP resulting from solid fuel use in a low or middle-income country. Results The review identified 5,243 records. Of these, 258 abstracts and 57 full texts were reviewed and 36 studies identified which met the inclusion criteria. When well-designed, implemented and monitored, stove interventions can have positive effects. However, the impacts are unlikely to reduce pollutant levels to World Health Organization recommended levels. Additionally, many participants in the included studies continued to use traditional stoves either instead of, or in additional to, new improved options. Conclusions Current evidence suggests improved stove interventions can reduce exposure to HAP resulting from solid fuel smoke. Studies with longer follow-up periods are required to assess if pollutant reductions reported in the current literature are sustained over time. Adoption of new technologies is challenging and interventions must be tailored to the needs and preferences of the households of interest. Future studies require greater process evaluation to improve knowledge of implementation barriers and facilitators. Review registration The review was registered on Prospero (registration number CRD42014009796 ). Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2024-7) contains supplementary material, which is available to authorized users.
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Wylie BJ, Singh MP, Coull BA, Quinn A, Yeboah-Antwi K, Sabin L, Hamer DH, Singh N, MacLeod WB. Association between wood cooking fuel and maternal hypertension at delivery in central East India. Hypertens Pregnancy 2015; 34:355-68. [PMID: 26153626 DOI: 10.3109/10641955.2015.1046604] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Smoke from burning of biomass fuels has been linked with adverse pregnancy outcomes and hypertension among nonpregnant subjects; association with hypertension during pregnancy has not been well studied. We evaluated whether the use of wood cooking fuel increases the risk of maternal hypertension at delivery compared to gas which burns with less smoke. METHODS Information on fuel use and blood pressure was available for analysis from a cross-sectional survey of 1369 pregnant women recruited at delivery in India. RESULTS Compared to gas users, women using wood as fuel had on average lower mean arterial pressure (adjusted effect size - 2.0 mmHg; 95% CI: -3.77, -0.31) and diastolic blood pressure (adjusted effect size -1.96 mmHg; 95% CI: -3.60, -0.30) at delivery. Risk of hypertension (systolic >139 mmHg or diastolic >89 mmHg) was 14.6% for wood users compared to 19.6% for gas users although this did not reach significance after adjustment, using propensity score techniques, for factors that make wood and gas users distinct (adjusted prevalence ratio 0.76; 95% CI: 0.49, 1.17). CONCLUSIONS Combustion products from the burning of biomass fuels are similar to those released with tobacco smoking, which has been linked with a reduced risk for preeclampsia. The direction of our findings suggests the possibility of a similar effect for biomass cook smoke. Whether clean cooking interventions being promoted by international advocacy organizations will impact hypertension in pregnancy warrants further analysis as hypertension remains a leading cause of maternal death worldwide and cooking with biomass fuels is widespread.
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Affiliation(s)
- Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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50
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Morishita M, Thompson KC, Brook RD. Understanding Air Pollution and Cardiovascular Diseases: Is It Preventable? CURRENT CARDIOVASCULAR RISK REPORTS 2015; 9. [PMID: 26097526 DOI: 10.1007/s12170-015-0458-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Fine particulate matter (<2.5 µm, PM2.5) air pollution is a leading risk factor for morbidity and mortality worldwide. The largest portion of adverse health effects is from cardiovascular diseases. In North America, PM2.5 concentrations have shown a steady decline over the past several decades; however, the opposite trend has occurred throughout much of the developing world whereby daily concentrations commonly reach extraordinarily high levels. While air quality regulations can reduce air pollution at a societal level, what individuals can do to reduce their personal exposures remains an active field of investigation. Here, we review the emerging evidence that several interventions (e.g., air filters) and/or behavioral changes can lower PM pollution exposure and as such, may be capable of mitigating the ensuing adverse cardiovascular health consequences. Air pollution remains a worldwide epidemic and a multi-tiered prevention strategy is required in order to optimally protect global public health.
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Affiliation(s)
- Masako Morishita
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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