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Kephart JL, Gouveia N, Rodríguez DA, Indvik K, Alfaro T, Texcalac-Sangrador JL, Miranda JJ, Bilal U, Diez Roux AV. Ambient nitrogen dioxide in 47 187 neighbourhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. Lancet Planet Health 2023; 7:e976-e984. [PMID: 38056968 PMCID: PMC10716820 DOI: 10.1016/s2542-5196(23)00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighbourhood ambient NO2 in 326 Latin American cities. METHODS We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighbourhood level (ie, census tracts). We described the percentage of the urban population living with ambient NO2 concentrations exceeding WHO air quality guidelines. We used multilevel models to describe associations of neighbourhood ambient NO2 concentrations with population and urban characteristics at the neighbourhood and city levels. FINDINGS We examined 47 187 neighbourhoods in 326 cities from eight Latin American countries. Of the roughly 236 million urban residents observed, 85% lived in neighbourhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighbourhood-level educational attainment, closer proximity to the city centre, and lower neighbourhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. INTERPRETATION Almost nine out of every ten residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighbourhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. FUNDING Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel A Rodríguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | - Katherine Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - José Luis Texcalac-Sangrador
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Kephart JL, Gouveia N, Rodriguez DA, Indvik K, Alfaro T, Texcalac JL, Miranda JJ, Bilal U, Roux AVD. Ambient nitrogen dioxide in 47,187 neighborhoods across 326 cities in eight Latin American countries: population exposures and associations with urban features. medRxiv 2023:2023.05.02.23289390. [PMID: 37205591 PMCID: PMC10187449 DOI: 10.1101/2023.05.02.23289390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Health research on ambient nitrogen dioxide (NO2) is sparse in Latin America, despite the high prevalence of NO2-associated respiratory diseases in the region. This study describes within-city distributions of ambient NO2 concentrations at high spatial resolution and urban characteristics associated with neighborhood ambient NO2 in 326 Latin American cities. Methods We aggregated estimates of annual surface NO2 at 1 km2 spatial resolution for 2019, population counts, and urban characteristics compiled by the SALURBAL project to the neighborhood level (i.e., census tracts). We described the percent of the urban population living with ambient NO2 levels exceeding WHO Air Quality Guidelines. We used multilevel models to describe associations of neighborhood ambient NO2 concentrations with population and urban characteristics at the neighborhood and city levels. Findings We examined 47,187 neighborhoods in 326 cities from eight Latin American countries. Of the ≈236 million urban residents observed, 85% lived in neighborhoods with ambient annual NO2 above WHO guidelines. In adjusted models, higher neighborhood-level educational attainment, closer proximity to the city center, and lower neighborhood-level greenness were associated with higher ambient NO2. At the city level, higher vehicle congestion, population size, and population density were associated with higher ambient NO2. Interpretation Almost nine out of every 10 residents of Latin American cities live with ambient NO2 concentrations above WHO guidelines. Increasing neighborhood greenness and reducing reliance on fossil fuel-powered vehicles warrant further attention as potential actionable urban environmental interventions to reduce population exposure to ambient NO2. Funding Wellcome Trust, National Institutes of Health, Cotswold Foundation.
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Affiliation(s)
- Josiah L. Kephart
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel A. Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, California, USA
| | - Katy Indvik
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Tania Alfaro
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - José Luis Texcalac
- Department of Environmental Health, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Fandiño-Del-Rio M, Kephart JL, Williams KN, Shade T, Adekunle T, Steenland K, Naeher LP, Moulton LH, Gonzales GF, Chiang M, Hossen S, Chartier RT, Koehler K, Checkley W. Household Air Pollution Concentrations after Liquefied Petroleum Gas Interventions in Rural Peru: Findings from a One-Year Randomized Controlled Trial Followed by a One-Year Pragmatic Crossover Trial. Environ Health Perspect 2022; 130:57007. [PMID: 35549716 PMCID: PMC9097958 DOI: 10.1289/ehp10054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. OBJECTIVE Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. METHODS We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. RESULTS Baseline mean [ ± standard deviation ( SD ) ] PM 2.5 (kitchen area concentrations 1,220 ± 1,010 vs. 1,190 ± 880 μ g / m 3 ; personal exposure 126 ± 214 vs. 104 ± 100 μ g / m 3 ), CO (kitchen 53 ± 49 vs. 50 ± 41 ppm ; personal 7 ± 8 vs. 7 ± 8 ppm ), and BC (kitchen 180 ± 120 vs. 210 ± 150 μ g / m 3 ; personal 19 ± 16 vs. 21 ± 22 μ g / m 3 ) were similar between control and intervention participants. Intervention participants had consistently lower mean ( ± SD ) concentrations at the 12-month visit for kitchen (41 ± 59 μ g / m 3 , 3 ± 6 μ g / m 3 , and 8 ± 13 ppm ) and personal exposures (26 ± 34 μ g / m 3 , 2 ± 3 μ g / m 3 , and 3 ± 4 ppm ) to PM 2.5 , BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM 2.5 , BC, and CO kitchen mean concentrations of 34 ± 74 μ g / m 3 , 3 ± 5 μ g / m 3 , and 6 ± 6 ppm and personal exposures of 17 ± 15 μ g / m 3 , 2 ± 2 μ g / m 3 , and 3 ± 4 ppm , respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM 2.5 , BC, and CO kitchen mean concentrations of 561 ± 1,251 μ g / m 3 , 82 ± 124 μ g / m 3 , and 23 ± 28 ppm and personal exposures of 35 ± 38 μ g / m 3 , 6 ± 6 μ g / m 3 , and 4 ± 5 ppm , respectively). DISCUSSION Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.
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Affiliation(s)
- Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
| | - Josiah L. Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kendra N. Williams
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Timothy Shade
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
| | - Temi Adekunle
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Luke P. Naeher
- Environmental Health Science Department, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lawrence H. Moulton
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gustavo F. Gonzales
- Laboratories of Investigation and Development, Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
- High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marilu Chiang
- Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Perú
| | - Shakir Hossen
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cardiopulmonary outcomes and Household Air Pollution (CHAP) Trial Investigators
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Science Department, College of Public Health, University of Georgia, Athens, Georgia, USA
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Laboratories of Investigation and Development, Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
- High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Perú
- Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Perú
- RTI International, Durham, North Carolina, USA
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Gardner-Frolick R, Boyd D, Giang A. Selecting Data Analytic and Modeling Methods to Support Air Pollution and Environmental Justice Investigations: A Critical Review and Guidance Framework. Environ Sci Technol 2022; 56:2843-2860. [PMID: 35133145 DOI: 10.1021/acs.est.1c01739] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Given the serious adverse health effects associated with many pollutants, and the inequitable distribution of these effects between socioeconomic groups, air pollution is often a focus of environmental justice (EJ) research. However, EJ analyses that aim to illuminate whether and how air pollution hazards are inequitably distributed may present a unique set of requirements for estimating pollutant concentrations compared to other air quality applications. Here, we perform a scoping review of the range of data analytic and modeling methods applied in past studies of air pollution and environmental injustice and develop a guidance framework for selecting between them given the purpose of analysis, users, and resources available. We include proxy, monitor-based, statistical, and process-based methods. Upon critically synthesizing the literature, we identify four main dimensions to inform method selection: accuracy, interpretability, spatiotemporal features of the method, and usability of the method. We illustrate the guidance framework with case studies from the literature. Future research in this area includes an exploration of increasing data availability, advanced statistical methods, and the importance of science-based policy.
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Affiliation(s)
- Rivkah Gardner-Frolick
- Department of Mechanical Engineering, University of British Columbia, Vancouver V6T 1Z4, Canada
| | - David Boyd
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver V6T 1Z4, Canada
| | - Amanda Giang
- Department of Mechanical Engineering, University of British Columbia, Vancouver V6T 1Z4, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver V6T 1Z4, Canada
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Saenz JL. Solid cooking fuel use and cognitive decline among older Mexican adults. Indoor Air 2021; 31:1522-1532. [PMID: 33896051 PMCID: PMC8380681 DOI: 10.1111/ina.12844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 05/02/2023]
Abstract
Studies of air pollution and cognition often rely on measures from outdoor environments. Many individuals in low- and middle-income countries are exposed to indoor air pollution from combustion of solid cooking fuels. Little is known about how solid cooking fuel use affects cognitive decline over time. This study uses data from the 2012, 2015, and 2018 Mexican Health and Aging Study (n = 14 245, age 50+) to assess how use of wood or coal for cooking fuel affects cognition of older adults relative to use of gas. It uses latent change score modeling to determine how using solid cooking fuel affected performance in Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency. Solid cooking fuel was used by 17% of the full sample but was more common in rural areas. Solid fuel users also had lower socioeconomic status. Compared to those using gas, solid fuel users had lower baseline scores and faster decline in Verbal Learning (β = -0.18, p < 0.05), Visual Scanning (β = -1.00, p < 0.001), and Verbal Fluency (β = -0.33, p < 0.001). Indoor air pollution from solid cooking fuels may represent a modifiable risk factor for cognitive decline. Policy should focus on facilitating access to clean cooking fuels.
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Affiliation(s)
- Joseph L. Saenz
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA
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Fandiño-Del-Rio M, Kephart JL, Williams KN, Malpartida G, Barr DB, Steenland K, Koehler K, Checkley W. Household air pollution and blood markers of inflammation: A cross-sectional analysis. Indoor Air 2021; 31:1509-1521. [PMID: 33749948 PMCID: PMC8380676 DOI: 10.1111/ina.12814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/19/2021] [Indexed: 05/08/2023]
Abstract
Household air pollution (HAP) from biomass stoves is a leading risk factor for cardiopulmonary outcomes; however, its toxicity pathways and relationship with inflammation markers are poorly understood. Among 180 adult women in rural Peru, we examined the cross-sectional exposure-response relationship between biomass HAP and markers of inflammation in blood using baseline measurements from a randomized trial. We measured markers of inflammation (CRP, IL-6, IL-10, IL-1β, and TNF-α) with dried blood spots, 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM2.5 ), black carbon (BC), and carbon monoxide (CO), and 48-h kitchen concentrations of nitrogen dioxide (NO2 ) in a subset of 97 participants. We conducted an exposure-response analysis between quintiles of HAP levels and markers of inflammation. Markers of inflammation were more strongly associated with kitchen area concentrations of BC than PM2.5 . As expected, kitchen area BC concentrations were positively associated with TNF-α (pro-inflammatory) concentrations and negatively associated with IL-10, an anti-inflammatory marker, controlling for confounders in single- and multi-pollutant models. However, contrary to expectations, kitchen area BC and NO2 concentrations were negatively associated with IL-1β, a pro-inflammatory marker. No associations were identified for IL-6 or CRP, or for any marker in relation to personal exposures.
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Affiliation(s)
- Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L. Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Kendra N. Williams
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gary Malpartida
- Molecular Biology and Immunology Laboratory, Research Laboratory of Infectious Diseases, Department of Cell and Molecular Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
- Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Perú
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Braun M, Klingelhöfer D, Müller R, Groneberg DA. The impact of second-hand smoke on nitrogen oxides concentrations in a small interior. Sci Rep 2021; 11:11703. [PMID: 34083603 PMCID: PMC8175351 DOI: 10.1038/s41598-021-90994-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022] Open
Abstract
Nitrogen oxides (NOx), especially nitrogen dioxide (NO2), are among the most hazardous forms of air pollution. Tobacco smoke is a main indoor source of NOx, but little information is available about their concentrations in second-hand smoke (SHS), particularly in small indoors. This study presents data of NOx and its main components nitric oxide (NO) and NO2 in SHS emitted by ten different cigarette brands measured in a closed test chamber with a volume of 2.88 m3, similar to the volume of vehicle cabins. The results show substantial increases in NOx concentrations when smoking only one cigarette. The NO2 mean concentrations ranged between 105 and 293 µg/m3, the NO2 peak concentrations between 126 and 357 µg/m3. That means the one-hour mean guideline of 200 µg/m3 for NO2 of the World Health Organization was exceeded up to 47%, respectively 79%. The measured NO2 values show positive correlations with the values for tar, nicotine, and carbon monoxide stated by the cigarette manufacturers. This study provides NO2 concentrations in SHS at health hazard levels. These data give rise to the necessity of health authorities' measures to inform about and caution against NOx exposure by smoking in indoor rooms.
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Affiliation(s)
- Markus Braun
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Doris Klingelhöfer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Medical Entomology, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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8
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Kephart JL, Fandiño-Del-Rio M, Williams KN, Malpartida G, Lee A, Steenland K, Naeher LP, Gonzales GF, Chiang M, Checkley W, Koehler K. Nitrogen dioxide exposures from LPG stoves in a cleaner-cooking intervention trial. Environ Int 2021; 146:106196. [PMID: 33160161 PMCID: PMC8173774 DOI: 10.1016/j.envint.2020.106196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Liquefied petroleum gas (LPG) stoves have been promoted in low- and middle-income countries (LMICs) as a clean energy alternative to biomass burning cookstoves. OBJECTIVE We sought to characterize kitchen area concentrations and personal exposures to nitrogen dioxide (NO2) within a randomized controlled trial in the Peruvian Andes. The intervention included the provision of an LPG stove and continuous fuel distribution with behavioral messaging to maximize compliance. METHODS We measured 48-hour kitchen area NO2 concentrations at high temporal resolution in homes of 50 intervention participants and 50 control participants longitudinally within a biomass-to-LPG intervention trial. We also collected 48-hour mean personal exposures to NO2 among a subsample of 16 intervention and 9 control participants. We monitored LPG and biomass stove use continuously throughout the trial. RESULTS In 367 post-intervention 24-hour kitchen area samples of 96 participants' homes, geometric mean (GM) highest hourly NO2 concentration was 138 ppb (geometric standard deviation [GSD] 2.1) in the LPG intervention group and 450 ppb (GSD 3.1) in the biomass control group. Post-intervention 24-hour mean NO2 concentrations were a GM of 43 ppb (GSD 1.7) in the intervention group and 77 ppb (GSD 2.0) in the control group. Kitchen area NO2 concentrations exceeded the WHO indoor hourly guideline an average of 1.3 h per day among LPG intervention participants. GM 48-hour personal exposure to NO2 was 5 ppb (GSD 2.4) among 35 48-hour samples of 16 participants in the intervention group and 16 ppb (GSD 2.3) among 21 samples of 9 participants in the control group. DISCUSSION In a biomass-to-LPG intervention trial in Peru, kitchen area NO2 concentrations were substantially lower within the LPG intervention group compared to the biomass-using control group. However, within the LPG intervention group, 69% of 24-hour kitchen area samples exceeded WHO indoor annual guidelines and 47% of samples exceeded WHO indoor hourly guidelines. Forty-eight-hour NO2 personal exposure was below WHO indoor annual guidelines for most participants in the LPG intervention group, and we did not measure personal exposure at high temporal resolution to assess exposure to cooking-related indoor concentration peaks. Further research is warranted to understand the potential health risks of LPG-related NO2 emissions and inform current campaigns which promote LPG as a clean-cooking option.
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Affiliation(s)
- Josiah L Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kendra N Williams
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gary Malpartida
- Molecular Biology and Immunology Laboratory, Research Laboratory of Infectious Diseases, Department of Cell and Molecular Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | | | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Gustavo F Gonzales
- Laboratories of Investigation and Development, Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru; High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marilu Chiang
- Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Fandiño-Del-Rio M, Kephart JL, Williams KN, Moulton LH, Steenland K, Checkley W, Koehler K. Household air pollution exposure and associations with household characteristics among biomass cookstove users in Puno, Peru. Environ Res 2020; 191:110028. [PMID: 32846169 PMCID: PMC7658004 DOI: 10.1016/j.envres.2020.110028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/29/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Household air pollution (HAP) from combustion of biomass fuel, such as wood and animal dung, is among the leading environmental risk factors for preventable disease. Close to half of the world's population relies on biomass cookstoves for their daily cooking needs. Understanding factors that affect HAP can inform measures to maximize the effectiveness of cookstove interventions in a cost-effective manner. However, the impact of kitchen and household characteristics, as well as the presence of secondary stoves, on HAP concentrations is poorly understood in Puno, Peru. OBJECTIVE To explore how household characteristics explain variability of kitchen area concentrations and personal exposures to CO, PM2.5 and BC from biomass cookstoves among women in rural Peru. METHODS Household characteristics (including kitchen materials and layout, wealth, and cooking behaviors) and HAP measurements were collected from 180 households in Puno, Peru, from baseline measurements of a randomized trial. Kitchen area concentrations and personal exposures to carbon monoxide (CO), fine particulate matter (PM2.5) and black carbon (BC) were sampled for 48 h. We implemented simple and multivariable linear regression models to determine the associations between household characteristics and both kitchen area concentration and personal exposure to each pollutant. RESULTS Mean daily kitchen area concentrations and personal exposures to HAP were, on average, 48 times above World Health Organization indoor guidelines for PM2.5. We found that roof type explained the most variability in HAP and was strongly associated with both kitchen area concentrations and personal exposures for all pollutants after adjusting for other household variables. Personal exposures were 27%-36% lower for PM2.5, CO and BC, in households with corrugated metal roofs, compared to roofs made of natural materials (straw, totora or reed) after adjusting for other factors. Higher kitchen area concentrations were also associated with less wealth, owning more animals, or sampling during the dry season in multivariable models. Having a liquefied petroleum gas (LPG) stove and having a chimney were associated with lower personal exposures, but were not associated with kitchen area concentrations. Personal exposures were lower by 21% for PM2.5 and 28% for CO and BC concentrations among participants who had both LPG and biomass stoves compared to those with only biomass cookstoves adjusting for other household factors. CONCLUSIONS Characterizing HAP within different settings can help identify effective and culturally-relevant solutions to reduce HAP exposures. We found that housing roof type is strongly related to kitchen area concentrations and personal exposures to HAP, perhaps because of greater ventilation in kitchens with metal roofs compared to those with thatch roofs. Although HAP concentrations remained above guidelines for all households, promoting use of metal roof materials and LPG stoves may be actionable interventions that can help reduce exposures to HAP in high-altitude rural Peru and similar settings.
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Affiliation(s)
- Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Josiah L Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kendra N Williams
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Lawrence H Moulton
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Williams KN, Kephart JL, Fandiño-Del-Rio M, O'Brien CJ, Moulton LH, Koehler K, Harvey SA, Checkley W. Use of liquefied petroleum gas in Puno, Peru: Fuel needs under conditions of free fuel and near-exclusive use. Energy Sustain Dev 2020; 58:150-157. [PMID: 33442225 PMCID: PMC7799435 DOI: 10.1016/j.esd.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Reducing the burden of household air pollution could be achieved with exclusive adoption of cleaner fuels such as liquefied petroleum gas (LPG). However, we lack understanding of how much LPG is required to support exclusive use and how household characteristics affect this quantity. This paper used data from 90 participants in the Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial in Puno, Peru who received free LPG deliveries for one year. Households with a mean of four members that cooked nearly exclusively (>98%) with LPG used an average of 19.1 kg (95% CI 18.5 to 19.6) of LPG per month for tasks similar to those done with the traditional biomass stove. LPG use per month was 0.5 kg higher for each additional pig or dog owned (p=0.003), 0.7 kg higher for each additional household member (p<0.001), 0.3 kg higher for households in the second-lowest compared to the lowest wealth quintile (p=0.01), and 1.1 kg higher if the household had previously received subsidized LPG (p=0.05). LPG use per month was 1.1 kg lower during the rainy season (p<0.001) and 1.7 kg lower during the planting season (p<0.001) compared to the cold and harvest seasons, despite the fact that LPG was not typically used for space heating. LPG use decreased by 0.05 kg per month over the course of one year after receiving the LPG stove (p=0.02). These results suggest that achieving exclusive LPG use in Puno, Peru requires that rural residents have affordable access to an average of two 10 kg LPG tanks per month. Conducting similar investigations in other countries could help policymakers set and target LPG subsidies to ensure that households have access to enough LPG to achieve exclusive LPG use and the potential health benefits.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn J O'Brien
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Williams KN, Kephart JL, Fandiño-Del-Rio M, Condori L, Koehler K, Moulton LH, Checkley W, Harvey SA. Beyond cost: Exploring fuel choices and the socio-cultural dynamics of liquefied petroleum gas stove adoption in Peru. Energy Res Soc Sci 2020; 66:101591. [PMID: 32742936 PMCID: PMC7394288 DOI: 10.1016/j.erss.2020.101591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Reducing the burden of household air pollution requires that cleaner fuels such as liquefied petroleum gas (LPG) be used nearly exclusively. However, exclusive adoption has been challenging in low- and middle-income countries. Previous studies have found that economic, social, and cultural barriers often impede adoption. We conducted in-depth qualitative interviews with 22 participants in a research trial where LPG was provided for free in Puno, Peru. We aimed to determine whether social and cultural barriers to LPG use persisted when monetary costs to the household were removed, and what factors influenced exclusive adoption of LPG in a cost-free context. Facilitators of LPG use included: support from study staff, family support, time savings, previous experience with LPG, stove design, ability to use existing pots, smoke reductions, desire for cleanliness, removal of traditional stoves, and perceptions of luck. Barriers to LPG use included: fears of LPG, problems with LPG brands, delays in obtaining LPG refills, social pressure, perceived incompatibility of traditional dishes, perceived inability to use clay pots, separate kitchens for LPG and traditional stoves, designated pots for use on the traditional stove, and lack of heat. However, these barriers did not prevent participants from using LPG nearly exclusively. Results suggest that social and cultural barriers to exclusive LPG use can be overcome when LPG stoves and fuel are provided for free and supplemented with behavioral support. Governments should evaluate the economic feasibility and sustainability of LPG subsidization, considering the potential benefits of exclusive LPG use.
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Affiliation(s)
- Kendra N Williams
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leonora Condori
- Biomedical Research Unit, Asociación Benéfica PRISMA, Puno, Peru
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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