Public health. A major environmental cause of death

Association of Exposure to Indoor Air Pollution with Unhealthy Symptoms among Middle-aged and Older Adults in India: Evidence from a Large-scale Survey

Background

The usage of solid cooking fuels is widely prevalent in low and middle-income countries, including India, and contributes to indoor air pollution (IAP), which has detrimental health effects. Moreover, time spent inside the house increases as people age. In this context, the present study tried to understand the association between exposure to indoor air pollution and unhealthy symptoms, including shortness of breath, dizziness, headache, fatigue, wheezing, and cough among middle-aged and older adults in India.

Methods

We extracted the unit-level individual data (N = 63 790) from the Longitudinal Aging Study in India (LASI)-Wave 1 (2017-2018). The statistical analyses used were Chi-square test and binary logistic regression, which estimated the odds ratio to identify the determinants of the unhealthy symptoms.

Results

The odds of shortness of breath (adjusted OR: 1.14, 99% CI: 1.05-1.23), dizziness (adjusted OR: 1.28, 99% CI: 1.21-1.35), fatigue (adjusted OR: 1.32, 99% CI: 1.26-1.39), wheezing (adjusted OR: 1.30, 99% CI: 1.19-1.42), and cough (adjusted OR: 1.36, 99% CI: 1.27-1.45) were higher among individuals from households where solid cooking fuels was used. Similarly, the odds of shortness of breath, headache, wheezing, and cough were higher among individuals with a household member who smoked inside the house. The results indicated that the odds of shortness of breath, headache, and cough were significantly lower among participants exposed to incense use.

Conclusion

Based on the results of this study, we suggest developing programs to combat the sources of indoor air pollution and the associated unhealthy symptoms, especially in rural settings. It is also important to bring awareness and practice clean fuel usage at individual and community levels to improve population health.

The effect of living environmental factors on cardiovascular diseases in Chinese adults: results from a cross-sectional and longitudinal study

AIMS

This study aimed to investigate the association between multiple living environmental factors and cardiovascular diseases (CVDs).

METHODS AND RESULTS

This study was conducted on the China Health and Retirement Longitudinal Study (CHARLS), with 12 489 subjects in the cross-sectional study and 7932 subjects in the 7-year follow-up. Living environmental factors included ambient fine particulate matter (PM2.5), indoor fuel use, tap water use, and residence type. Logistic regression and Cox proportional hazard regression models were applied to explore the association between living environmental risk factors and CVD events in a cross-sectional and a cohort analysis, respectively. Compared with subjects in the low-risk groups, those in the middle-risk (odd ratio [OR], 95% confidence interval [CI]: 1.203, 0.943-1.534) and high-risk groups (OR, 95% CI: 1.616, 1.259-2.074) showed increased risks of CVD prevalence when considering the combined effects of their living environment. During the follow-up, similar associations were observed (hazard ratio [HR], 1.541, 95% CI [1.142-2.080] for the high-risk group; HR 1.296, 95% CI [0.968-1.736] for the middle-risk group); P for trend = 0.003).

CONCLUSION

An overall poor living environmental quality is a potential risk factor for CVD. Future studies should focus more on the effects of exposure to multiple factors.

Association between living environmental quality and risk of arthritis in middle-aged and older adults: a national study in China

Background

The association between combined environmental factors and the risk of arthritis is still scarcely studied. The present study performed cross-sectional and cohort studies to explore the association between risk score of living environment quality and the risk of arthritis in middle-aged and older adults in China.

Methods

The study was based on China Health and Retirement Longitudinal Study (CHARLS), and it recruited 17,218 participants in the cross-sectional study and 11,242 participants in the seven-year follow-up study. The living environment quality was measured by household fuel types, household water sources, room temperature, residence types, and ambient concentration of PM2.5. Logistic regression and Cox proportional hazard regression models were utilized to examine the association between the living environment quality and the risk of arthritis. Competing risk models and stratified analyses were applied to further verify our results.

Results

Compared with individuals in the suitable environment group, people who lived in moderate (OR:1.28, 95%CI: 1.14-1.43) and unfavorable environments (OR:1.49, 95%CI:1.31-1.70) showed higher risks of arthritis when considering the multiple living environmental factors (P for trend <0.001) in the cross-sectional analysis. In the follow-up study, similar results (P for trend = 0.021), moderate environment group (HR:1.26, 95%CI:1.01-1.56) and unfavorable environment group (HR: 1.36, 95%CI: 1.07-1.74), were founded.

Conclusion

Inferior living environment might promote the development of arthritis. It is necessary for the public, especially old people, to improve the living environment, which may be the key to the primary prevention of arthritis.

A scientometric analysis of indoor air pollution research during 1990-2019

Indoor air pollution (IAP) is one of the leading risk factors for various adverse health outcomes including premature deaths globally. Even though research related to IAP has been carried out, bibliometric studies with particular emphasis on this topic have been lacking. Here, we investigated IAP research from 1990 to 2019 retrieved from the Web of Science database through a comprehensive and systematic scientometric analysis using the CiteSpace 5.7.R2, a powerful tool for visualizing structural, temporal patterns and trends of a scientific field. There was an exponential increase in publications, however, with a stark difference between developed and developing countries. The journals publishing IAP related research had multiple disciplines; 'Indoor Air' journal that focuses solely on IAP issues ranked fifth among top-cited journals. The terms like 'global burden', 'comparative risk assessment,' 'household air pollution (HAP)', 'ventilation', 'respiratory health', 'emission factor', 'impact,' 'energy', 'household', 'India' were the current topical subject where author Kirk R. Smith was identified with a significant contribution. Research related to rural, fossil-fuel toxicity, IAP, and exposure-assessment had the highest citation burst signifying the particular attention of scientific communities to these subjects. Overall, this study examined the evolution of IAP research, identified the gaps and provided future research directions.

Dung biomass smoke exposure impairs resolution of inflammatory responses to influenza infection

Epidemiological studies associate biomass smoke with an increased risk for respiratory infections in children and adults in the developing world, with 500,000 premature deaths each year attributed to biomass smoke-related acute respiratory infections including infections caused by respiratory viruses. Animal dung is a biomass fuel of particular concern because it generates more toxic compounds per amount burned than wood, and is a fuel of last resort for the poorest households. Currently, there is little biological evidence on the effects of dung biomass smoke exposure on immune responses to respiratory viral infections. Here, we investigated the impact of dung biomass exposure on respiratory infection using a mouse model of dung biomass smoke and cultured primary human small airway epithelial cells (SAECs). Mice infected with influenza A virus (IAV) after dung biomass smoke exposure had increased mortality, lung inflammation and virus mRNA levels, and suppressed expression of innate anti-viral mediators compared to air exposed mice. Importantly, there was still significant tissue inflammation 14 days after infection in dung biomass smoke-exposed mice even after inflammation had resolved in air-exposed mice. Dung biomass smoke exposure also suppressed the production of anti-viral cytokines and interferons in cultured SAECs treated with poly(I:C) or IAV. This study shows that dung biomass smoke exposure impairs the immune response to respiratory viruses and contributes to biomass smoke-related susceptibility to respiratory viral infections, likely due to a failure to resolve the inflammatory effects of biomass smoke exposure.

Unani medicinal herbs as potential air disinfectants: an evidence-based review

OBJECTIVES

Indoor air quality has a significant impact on our health and quality of life, as people spends 80-90% of their time indoors. Fumigation of several medicinal herbs has been recommended by Unani scholars to improve air quality, but their efficacy in air purification is still unknown. Hence, this article aims to discuss the applicability of proposed medicinal herbs in the light of current researches.

METHODS

A manual literature survey of classical Unani texts was conducted to collect information about the herbs recommended for air purification. In addition, research databases such as PubMed, Google Scholar, and ScienceDirect were extensively searched for evidence on the efficacy and mechanism of action of the suggested herbs in air purification.

RESULTS

In classical Unani texts, authors have found descriptions of 26 herbs that have been recommended for improving air quality. In-vitro studies have confirmed the antimicrobial activity of 19 of these herbs. Moreover, the efficacy of Styrax benzoin, Commiphora myrrha and Acorus calamus fumigation on aerial microbes have also been validated by studies.

CONCLUSIONS

The findings of the literature review clearly demonstrated that the herbs recommended by Unani scholars for air purification have broad-spectrum antimicrobial activity, indicating that these herbs could be a potential candidate for air disinfectant. Therefore, authors recommend the further researches on proposed herbs to validate their efficiency against airborne pathogens in the vapour phase.

Indoor solid fuel use and renal function among middle-aged and older adults: A national study in rural China

Solid fuel use is the main source of indoor air pollution, especially in rural areas of developing countries. Nevertheless, the evidence linking indoor solid fuel use and renal function is very limited. Therefore, we investigated the association between indoor solid fuel use and renal function among middle-aged and older adults in rural China. Cystatin C (CysC) concentration of each participant was used to calculate the estimated glomerular filtration rate (eGFR). We used the baseline data to investigate the associations between solid fuel use for cooking and heating and eGFR through a linear-mixed effects model. Then, we applied the generalized linear-mixed effects model with binary distribution to examine the relationship between renal function decline and cooking fuel switching from 2011 to 2015. A total of 4959 participants were included at baseline, and 3536 participants were included in the follow-up analysis. Compared to participants who used clean fuel for both cooking and heating, the eGFR was significantly lower among participants who cooked with solid fuel and heated with clean fuel (β: -2.81; 95% CI: -5.53, -0.09). In the follow-up analysis, the risks of renal function decline for participants using solid fuel for cooking were significantly higher in males (OR: 2.74; 95% CI: 1.68, 4.49), smokers (OR: 5.70; 95% CI: 2.82, 11.55), and drinkers (OR: 7.11; 95% CI: 3.15, 16.02) compared to females, non-smokers, and non-drinkers. Moreover, 45-65 years aged participants (OR: 0.54; 95% CI: 0.33, 0.89) and non-drinkers (OR: 0.61; 95% CI: 0.41, 0.92) who switched from solid to clean cooking fuel had a lower risk of renal function decline. In conclusion, our findings show that household solid fuel use is likely to be an important risk factor for renal function decline in rural China. And switching to cleaner fuel may provide significant public health benefits.

Frequency of Pulmonary Anthracosis and its Related Factors in Autopsy Specimens in Guilan, Iran, in 2019

Background

Anthracosis is caused by several factors and is a risk factor for cancer and tuberculosis. This study investigated the prevalence of anthracosis and the associated factors in autopsy specimens from the Guilan Office of the Iranian Legal Medicine Organization.

Materials and Methods

This retrospective study examined the medical records of autopsy specimens (>18 years) in the Guilan Office of the Iranian Legal Medicine Organization in 2019 for pulmonary anthracosis. Data were extracted from the autopsy findings, and demographic characteristics, occupational information, tuberculosis or pulmonary cancer history, and anthracosis were recorded in a checklist. SPSS version 16 was used to analyze the collected data.

Results

The study included 190 autopsy specimens with a 32.1% anthracosis prevalence. Forty-five (23.7%) subjects had anthracofibrosis. Individuals with agricultural carriers or who worked in tobacco fields had the highest prevalence of anthracosis. The frequency of pulmonary cancer and tuberculosis was significantly higher in the specimens with anthracosis (anthracosis group) than in the non-anthracosis group (P<0.05). The use of traditional cooking and heating methods, as well as exposure to carbon and smoke in the workplace, were significantly higher in the anthracosis group than in the non-anthracosis group (P<0.05).

Conclusion

The results of the current study revealed that occupational exposure, tuberculosis, pulmonary cancer, and traditional indoor cooking and heating methods were all associated with anthracosis.

Housing and Health: Here We Go Again

Housing is one of the major determinants of human health and the current COVID-19 pandemic has highlighted its relevance. The authors summarize the main issues, including dimensional standards, indoor air quality, safety, accessibility, neighborhoods, and area characteristics. The authors propose an operating scheme in order to implement actions to improve residential wellbeing on a local, national, and international level.

Indoor solid fuel use for heating and cooking with blood pressure and hypertension: A cross-sectional study among middle-aged and older adults in China

A cross-sectional study was conducted to investigate the impact of solid fuel use for heating and cooking on blood pressure (BP) and hypertension, using data from the China Health and Retirement Longitudinal Study (CHARLS). The primary fuels used for indoor heating and cooking were collected by questionnaires, respectively. Hypertension was defined based on self-report of physician's diagnosis, and/or measured BP, and/or anti-hypertensive medication use. Multivariate logistic regression models were constructed to assess the associations. Among 10 450 eligible participants, 68.2% and 57.2% used indoor solid fuel for heating and cooking, respectively. Compared with none/clean fuel users, solid fuel for heating was associated with elevated BP (adjusted β: 2.02, 95% CI: 1.04-3.01 for systolic BP; adjusted β: 1.36, 95% CI: 0.78-1.94 for diastolic BP) and increased risk of hypertension (adjusted odds ratio: 1.15, 95% CI: 1.03-1.29). The impact of indoor solid fuel for heating on BP was more evident in rural and north residents, and hypertensive patients. We did not detect any significant associations between solid fuel use for cooking and BP/hypertension. Indoor solid fuel use is prevalent in China, especially in the rural areas. Its negative impact on BP suggested that modernization of household fuel use may help to reduce the burden of hypertension in China.

Exploring the impact of a liquefied petroleum gas intervention on time use in rural Peru: A mixed methods study on perceptions, use, and implications of time savings

BACKGROUND

Efforts to promote clean cooking through adoption of clean-burning fuels such as liquefied petroleum gas (LPG) are often based on the idea that near-exclusive use of LPG could lead to health improvements. However, benefits beyond health, such as time savings, could be more tangible and meaningful to LPG users.

OBJECTIVES

This study investigated the effect of an LPG intervention on time spent cooking and collecting fuel, using objective measures of stove temperatures combined with self-reports under conditions of near-exclusive LPG use. We also investigated the perceived value of any time savings and potential economic and quality of life implications.

METHODS

We analyzed data from the Cardiopulmonary outcomes and Household Air Pollution trial in Puno, Peru, a randomized controlled trial with 180 participants assessing exposure and health impacts of an LPG stove, fuel, and behavioral intervention. Surveys conducted with 90 intervention women receiving free LPG and 90 control women cooking primarily with biomass assessed time spent cooking and collecting biomass fuel and use of time savings. Cooking time was objectively measured with temperature sensors on all stoves. Qualitative interviews explored perceptions and use of time savings in more depth.

RESULTS

Intervention women spent 3.2 fewer hours cooking and 1.9 fewer hours collecting fuel per week compared to control women, but cooked on average 1.0 more meals per day. Participants perceived time saved from LPG positively, reporting more time for household chores, leisure activities, and activities with income-generating potential such as caring for animals and working in fields.

DISCUSSION

This paper suggests that the benefits of LPG extend beyond health and the environment. LPG use could also lead to economic and quality of life gains, through increased time for work, rest, and consumption of hot meals, and reduced arduous biomass fuel collection.

The long-run and short-run influence of environmental pollution, energy consumption, and economic activities on health quality in emerging countries

This study investigates the effect of energy utilization, greenhouses gasses emissions, and economic activities on health risks such as mortality rate and incidence of respiratory diseases in emerging Asian economies. The study analyzes a panel data from 1995 to 2018 to examine the long-run and short-run influence of environmental pollution on health issues. The empirical findings highlight that greenhouse gasses emissions, fossil fuel consumption, and natural resources depletion in the region are key factors to increasing health risks in the long-run period, while the use of clean energy and improvement in per capita economic growth is helping to improve the health status of the households. In a short period, greenhouse gasses emission is the only significant factor responsible for the high mortality rate and occurrence of respiratory diseases in the emerging economies of Asia. According to the results, there is a need for government intervention programs to rescue the region from the negative effects of environmental pollution and the utilization of nonrenewable energy. In emerging Asian countries, the combustion of fossil fuels, environmental pollution, and limited access to clean energy are such factors responsible for high mortality rate and stimulating incidence of respiratory diseases in the individuals. The study suggests that alternative green energy can prove helpful to control greenhouse gasses emissions and to control health issues by improving environmental quality. The study further suggests that the use of clean energy from water, wind, and sunlight may prove helpful to meet the energy requirement at the domestic level and improve the health status of the individuals by reducing the incidence of respiratory diseases in emerging countries of Asia.

Beyond cost: Exploring fuel choices and the socio-cultural dynamics of liquefied petroleum gas stove adoption in Peru

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.

Determinants of household cooking fuels and their impact on women's health in rural Pakistan

Use of biomass with traditional cooking technologies causes indoor air pollution and is responsible for 3.5 million deaths globally. Women play the main role in biomass-based energy systems in developing countries. The current study attempted to estimate determinants of household cooking fuels and impacts of fuels on women's health in rural Pakistan. The results of the study show that 75.5% of the households in the study area use fuelwood, 44.4% use LPG, and 27.9% use crop residues for cooking. Households with LPG spend on average 3.02 h/day for cooking while households with biomass spend almost 4 h. Health expenditures of households using biomass are almost 25% higher than those using LPG. Use of traditional biomass with traditional devices was found to be having negative impacts on rural women's life. Household composition, education, income, access to electricity and LPG, and distance from the market were found to be significant factors affecting the choice of fuels for cooking. Clean energy and technologies and empowerment through education and awareness will help minimize the negative impacts of biomass fuels on women.

Smoke exposure from chronic biomass burning induces distinct accumulative systemic inflammatory cytokine alterations compared to tobacco smoking in healthy women

Long-term exposure to biomass-burning smoke (BS) is associated with chronic obstructive pulmonary disease (COPD), asthma, and other chronic inflammatory lung diseases. BS results from such processes as the burning of wood for indoor cooking and heating, with women and children having the highest exposure rate. This study aimed to analyze the accumulative alterations in cytokine levels associated with BS (from wood) compared to tobacco smoke (TS) in healthy adult women. The levels of 27 cytokines were analyzed in the serum of 100 women, including 40 tobacco smokers/non-exposed to BS (TS+/BS-), 30 never-smokers/exposed to BS (TS-/BS+) and 30 never-smokers/non-exposed to BS (TS-/BS-) as controls, using 27-Plex immunoassay. The chronic BS exposure index was rated at ≥100 h-years, and the tobacco-smoking index was ≥10 pack-years. Compared to TS-/BS-, TS+/BS- had higher levels of IL-2, IL-9, MCP-1, MIP-1β, and VEGF, while TS-/BS+ showed higher levels of IL-1ra, IL-6, IL-8, Eotaxin, IP-10, RANTES, and VEGF, presenting a distinct inflammatory profile that may favor an eosinophil-derived inflammatory response to BS exposure. Compared to TS+/BS-, TS-/BS+ expressed higher levels of IP-10 and IL-8, but lower levels of IL-2 and MIP-1β. Gene-disease database analysis showed that altered cytokines in both TS+/BS- and TS-/BS+ are associated with asthma, COPD, lung fibrosis, and lung cancer. In conclusion, chronic BS exposure induces distinct systemic inflammatory cytokine alterations compared to tobacco smokers in healthy women. These findings provide new insights into how long-term exposure to BS affects the inflammatory response-and potentially the health-of adult women.

Workflow for Comparison of Chemical and Biological Metrics of Filter Collected PM2.5

There is limited understanding of adverse health effect associations with chemical constituents of fine particulate matter (PM2.5) as well as the underlying mechanisms. We outlined a workflow to assess metrics, beyond concentration, using household and personal PM2.5 filter samples collected in India as a proof of concept for future large-scale studies. Oxidative potential, chemical composition (polycyclic aromatic hydrocarbons and elements), and bioactivity (developmental exposures in zebrafish) were determined. Significant differences were observed in all metrics between personal and household PM2.5 samples. This work established methods to characterize multiple metrics of PM2.5 to ultimately support the identification of more health-relevant metrics than concentration.

Use of Biochar-Producing Gasifier Cookstove Improves Energy Use Efficiency and Indoor Air Quality in Rural Households

Biomass fuels dominate the household energy mix in sub-Saharan Africa. Much of it is used inefficiently in poorly ventilated kitchens resulting in indoor air pollution and consumption of large amounts of wood fuel. Micro-gasification cookstoves can improve fuel use efficiency and reduce indoor air pollution while producing char as a by-product. This study monitored real-time concentrations of carbon monoxide (CO), carbon dioxide (CO2) and fine particulate matter (PM2.5), and amount of firewood used when households were cooking dinner. Twenty-five households used the gasifier cookstove to cook and five repeated the same test with three-stone open fire on a different date. With the gasifier, the average corresponding dinner time CO, CO2, and PM2.5 concentrations were reduced by 57%, 41%, and 79% respectively compared to three-stone open fire. The gasifier had average biomass-to-char conversion efficiency of 16.6%. If the produced char is used as fuel, households could save 32% of fuel compared to use of three-stone open fire and 18% when char is used as biochar, for instance. Adoption of the gasifier can help to reduce the need for firewood collection, hence reducing impacts on the environment while saving on the amount of time and money spent on cooking fuel.

Prevalence of chronic obstructive pulmonary disease (COPD) and its associated factors among adults in Abeshge District, Ethiopia: a cross sectional study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the major public health problems worldwide. Despite an increasing burden of COPD in the world, it is often a neglected disease in low income countries and COPD prevalence studies are rare in Sub-Saharan Africa. The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Ethiopia.

METHODS

A community based cross sectional study was conducted from February 5 to May 20, 2019 in Abeshge district, Southern Ethiopia. A total of 734 adults aged at least 30 years were selected using multistage cluster sampling technique and included in the study. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Moreover, all participants underwent spirometry. We defined COPD as a post-bronchodilator FEV1/FVC of less than 70%. Data were entered into Epi-data manager 4.4 and analyzed using SPSS version 23. Descriptive statistics and binary logistic regression analysis were used and p-value < 0.05 was considered as significant.

RESULTS

Of the 779 adults invited to participate, 734 adults (421 men and 313 women) were participated in this study. The mean (SD) age of the participants was 39.15 (± 9.36) years, within the age range of 30-75 years. The prevalence of COPD was 17.8% (95% confidence interval [CI], 15.1-20.6). Factors significantly associated with COPD were age above 50 years (adjusted odds ratio [AOR] = 1.91, 95% CI [1.10, 3.30]), being smoker (AOR = 4.54, 95% CI [2.69, 7.66]), Exposed to biomass smoke (AOR = 2.05, 95% CI [1.06, 3.95]) and poor ventilated kitchen (AOR = 4.12, 95% CI [2.67, 6.34]).

CONCLUSION

It is evident from this study that the prevalence of COPD in Ethiopia is high. Factors such as old age, cigarette smoking, exposure to biomass smoke and poor kitchen ventilation plays a role in the development of COPD.

Formation, characteristics, and applications of environmentally persistent free radicals in biochars: A review

Due to abundant biomass and eco-friendliness, biochar is exemplified as one of the most promising candidates to mediate the degradation of environmental contaminants. Recently, environmentally persistent free radicals (EPFRs) have been detected in biochars, which can activate S₂O₈^2- or H₂O₂ to generate reactive oxygen species for effective degradation of organic and inorganic contaminants. Comprehending the formation mechanisms of EPFRs in biochars and their interactions with contaminants is indispensable to further develop their environmental applications, e.g., direct and indirect EPFR-mediated removal of organics/inorganics by biochars. With reference to the information of EPFRs in environmental matrices, this article critically reviews the formation mechanisms, characteristics, interactions, and environmental applications of EPFRs in biochars. Synthesis conditions and loading of metals/organics are considered as key parameters controlling their concentrations, types, and activities. This review provides new and important insights into the fate and emerging applications of surface-bound EPFRs in biochars.

Experimental evidence on promotion of electric and improved biomass cookstoves

Three billion people rely on traditional stoves and solid fuels. These energy use patterns exacerbate the global climate crisis (via increased carbon emissions) and forest degradation/deforestation (via daily fuelwood collection), and expose billions to toxic air pollution generated by dirty fuels. Widespread adoption of improved cookstoves (which use cleaner fuels or burn solid fuels more efficiently) may ease this “triple burden,” but recent research casts doubt on their potential, given low and slow diffusion. We challenge this pessimism based on a multiyear, three-phase field study comprising diagnosis, design, and experimental testing involving 1,000 rural Indian households. We show that demand for these improved energy technologies is high when supply chains are robust, technologies match local needs, and income and liquidity constraints are relaxed.

Improved cookstoves (ICS) can deliver “triple wins” by improving household health, local environments, and global climate. Yet their potential is in doubt because of low and slow diffusion, likely because of constraints imposed by differences in culture, geography, institutions, and missing markets. We offer insights about this challenge based on a multiyear, multiphase study with nearly 1,000 households in the Indian Himalayas. In phase I, we combined desk reviews, simulations, and focus groups to diagnose barriers to ICS adoption. In phase II, we implemented a set of pilots to simulate a mature market and designed an intervention that upgraded the supply chain (combining marketing and home delivery), provided rebates and financing to lower income and liquidity constraints, and allowed households a choice among ICS. In phase III, we used findings from these pilots to implement a field experiment to rigorously test whether this combination of upgraded supply and demand promotion stimulates adoption. The experiment showed that, compared with zero purchase in control villages, over half of intervention households bought an ICS, although demand was highly price-sensitive. Demand was at least twice as high for electric stoves relative to biomass ICS. Even among households that received a negligible price discount, the upgraded supply chain alone induced a 28 percentage-point increase in ICS ownership. Although the bundled intervention is resource-intensive, the full costs are lower than the social benefits of ICS promotion. Our findings suggest that market analysis, robust supply chains, and price discounts are critical for ICS diffusion.

Assessment of carbon monoxide exposure in roadside food-vending shanties using coal cookstoves in Kolkata, India

Roadside food-vending shanties using coal cookstoves may be an important source of carbon monoxide (CO) exposure in megacities in India. The shanties are often small, congested and poorly ventilated, and very little is known about the level of human exposure to CO. Here, we assessed the level of exposure to CO in 25 roadside food-vending shanties using coal cookstoves in Kolkata, India. Portable electrochemical CO monitors were used to measure CO concentrations during peak and non-peak customer-periods in closed (blocked from three sides) and semi-closed (blocked from two sides) shanties. Measurements were taken where customers sit indoor about 5-7 ft away from the cookstoves. The shanties' ventilation rates were measured using tracer gas concentration-decay technique. Levels of blood carboxyhaemoglobin (COHb) and exhaled CO were estimated using regression models. The 1-hr time weighted average (TWA) indoor CO exposure levels ranged from 7.8 to 18.1 ppm during peak-periods, and 0.7-3.1 ppm during non-peak-periods. The exposure levels during peak-periods exceeded the USEPA's reference limit of 9 ppm in all cases in the closed shanties, and in 71% of cases in the semi-closed shanties. The ventilation rates ranged from 5.5 to 23.4 and 14.8 to 32.5 cubic feet per minute (cfm) per person for the closed and semi-closed shanties, respectively, indicating poor ventilation in some shanties. There was significant variation (p = 0.01) in the level of indoor CO exposure between peak and non-peak periods, and between shanty types. The estimated levels of blood COHb during peak and non-peak hours were 0.78 ± 0.7% and 0.35 ± 0.07%, respectively, that were within the normal physiological values in non-smokers.

Access to environmental health assets across wealth strata: Evidence from 41 low- and middle-income countries

INTRODUCTION

Low levels of household access to basic environmental health assets (EHAs)-including technologies such as clean cookstoves and bed nets or infrastructure such as piped water and electricity-in low- and middle-income countries (LMICs) are known to contribute significantly to the global burden of disease. This low access persists despite decades of promotion of many low-cost, life-saving technologies, and is particularly pronounced among poor households. This study aims to characterize variation in access to EHAs among LMIC households as a function of wealth, as defined by ownership of various assets.

METHODS

Demographic and Health Survey (DHS) data from 41 low- and middle-income countries were used to assess household-level access to the following EHAs: 1) improved water supply; 2) piped water supply; 3) improved sanitation; 4) modern cooking fuels; 5) electricity; and 6) bed nets. For comparison, we included access to mobile phones, which is considered a highly successful technology in terms of its penetration into poor households within LMICs. Ownership levels were compared across country-specific wealth quintiles constructed from household assets using bivariate analysis and multivariable linear regression models.

RESULTS

Access to EHAs was low among the households in the bottom three quintiles of wealth. Access to piped water, modern cooking fuels, electricity and improved sanitation, for example, were all below 50% for households in the bottom three wealth quintiles. Access to certain EHAs such as improved water supply and bed nets increased only slowly with concomitant increases in wealth, while gaps in access to other EHAs varied to a greater degree by wealth quintile. For example, disparities in access between the richest and poorest quintiles were greatest for electricity and improved sanitation. Rural households in all wealth quintiles had much lower levels of access to EHAs, except for bed nets, relative to urban households.

CONCLUSIONS

The findings of this study provide a basis for understanding how EHAs are distributed among poor households in LMICs, elucidate where inequalities in access are particularly pronounced, and point to a need for strategies that better reach the poor, if the global environmental burden of disease is to be reduced.

Clean cooking and the SDGs: Integrated analytical approaches to guide energy interventions for health and environment goals. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2018;42:152-159. [PMID: 29861575 PMCID: PMC5975963 DOI: 10.1016/j.esd.2017.11.003]

Development and implementation of clean cooking technology for households in low and middle income countries (LMICs) offer enormous promise to advance at least five Sustainable Development Goals (SDGs): 3. Good health and well-being; 5. Gender equality; 7. Affordable and clean energy; 13. Climate action; 15. Life on land. Programs are being implemented around the world to introduce alternative cooking technologies, and we are well on the way to achieving the goal set by the Global Alliance for Clean Cookstoves to reach 100 million homes with cleaner and more efficient cooking methods by 2020. Despite evidence that household air pollution (HAP) from solid fuel combustion is responsible for 3-4 million early deaths per year, many cookstove programs are motivated and/or financed by climate change mitigation schemes and deploy alternative stoves that use solid fuels such as wood and charcoal. However, recent studies have demonstrated that improved biomass-burning stoves typically only incrementally improve air quality and yield modest or minimal health benefits. Likewise, their contributions to climate change mitigation and other SDGs may be limited. Evidence indicates that cleaner fuels, such as liquefied petroleum gas (LPG), ethanol and biogas, offer greater potential benefits not only to health, but also greater progress towards climate goals and other relevant SDGs. We present a modeled estimate of these potential gains for a diverse group of 40 LMICs. Our model suggests that cookstove programs using LPG stoves and fuel will yield greater reductions in both Disability Adjusted Life Years and Global Warming Commitment in these countries than those using improved biomass stoves. Cost and infrastructure requirements for clean fuels such as LPG are widely recognized constraints. In view of these constraints we present an analytical method to simultaneously consider health and climate needs at the national level for the same 40 countries in the context of estimated LPG expansion potentials. Comparative analyses integrating priorities across SDGs at the national and regional levels may guide more practical and effective household energy development choices going forward.

Adoption and sustained use of cleaner cooking fuels in rural India: a case control study protocol to understand household, network, and organizational drivers

Background

Implementing efficient stoves and clean fuels in low and middle-income countries are critical for improving health of poor women and children and improve the environment. Cleaner biomass stoves, however, perform poorly against the World Health Organization’s indoor air quality guidelines. This has shifted the focus to systematic dissemination and implementation of cleaner cooking systems such as liquefied petroleum gas (LPG) among poor communities. Even when there is some uptake of LPG by poor communities, its sustained use has been low. Concurrent use of LPG with traditional biomass cookstoves compromises reductions in household air pollution and limits health and environmental dividends. Therefore understanding key drivers of adoption and sustained implementation of clean fuels among the poor is critical. There is a significant gap, however, in the research to understand determinants and sustained exclusive use of clean fuels in rural poor communities.

Methods/design

Using a case control study design, this study will explore the impact of affordability, accessibility, and awareness on adoption and sustained use of LPG among rural poor communities of India. The study uses a multistage random sampling to collect primary data from 510 households. Case group or LPG adopters constitute 255 households while control group or non-LPG adopters constitute the remaining 255 households. The study will deploy sophisticated stove use monitoring sensors in each of the stoves in 100 case group households to monitor stove use and stacking behavior (using clean and traditional systems of cooking) of participants for 12 months. Moreover, this will be the first study to explore the impact of personal social networks striated by gender on LPG adoption. This study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science evaluation framework.

Discussion

Lessons from this study will feed into a larger discussion on developing a pro-poor strategy to foster uptake and sustained use of cleaner cooking systems such as LPG. Understanding the determinants of adoption and sustained use of cleaner cooking systems through the RE-AIM framework will expand our insights on implementation of cleaner cooking systems among poor communities and will advance implementation science in the clean cooking sector. A thorough study of such implementation strategies is crucial to realize multiple UN Sustainable Development Goals on global health, climate change, and energy security.

Evidence of Biomass Smoke Exposure as a Causative Factor for the Development of COPD

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the lungs characterised by chronic inflammation, obstruction of airways, and destruction of the parenchyma (emphysema). These changes gradually impair lung function and prevent normal breathing. In 2002, COPD was the fifth leading cause of death, and is estimated by the World Health Organisation (WHO) to become the third by 2020. Cigarette smokers are thought to be the most at risk of developing COPD. However, recent studies have shown that people with life-long exposure to biomass smoke are also at high risk of developing COPD. Most common in developing countries, biomass fuels such as wood and coal are used for cooking and heating indoors on a daily basis. Women and children have the highest amounts of exposures and are therefore more likely to develop the disease. Despite epidemiological studies providing evidence of the causative relationship between biomass smoke and COPD, there are still limited mechanistic studies on how biomass smoke causes, and contributes to the progression of COPD. This review will focus upon why biomass fuels are used, and their relationship to COPD. It will also suggest methodological approaches to model biomass exposure in vitro and in vivo.

Firewood, smoke and respiratory diseases in developing countries-The neglected role of outdoor cooking

Smoke from cooking in the kitchen is one of the world’s leading causes of premature child death, claiming the lives of 500,000 children under five annually. This study analyses the role of outdoor cooking and the prevalence of respiratory diseases among children under five years by means of probit regressions using information from 41 surveys conducted in 30 developing countries from Asia, Africa and Latin America. I find that outdoor cooking reduces respiratory diseases among young children aged 0-4 by around 9 percent, an effect that reaches 13 percent among children aged 0-1. The results suggest that simple behavioral interventions, such as promoting outdoor cooking, can have a substantial impact on health hazards.

Knowledge and training needs on built environment and indoor health of Italian public health residents: a national survey

INTRODUCTION

The Working Group for Hygiene of Built Environment and the National Council of Residents of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a nation-wide survey to evaluate the knowledge and training needs on Built Environment and Indoor Health of Italian public health residents.

RESULTS

The compliance was very high (52,4%), covering the totality of Italian postgraduate schools. The results underline a severe lack of theoretical formation and practical training, but also diffuse discrepancies across the country, and show a strong interest of residents on this topic.

CONCLUSIONS

The authors propose to adopt a national core curriculum, and suggest some strategies to improve learning.

Comparison of in vitro toxicological effects of biomass smoke from different sources of animal dung

Worldwide, over 4 million premature deaths each year are attributed to the burning of biomass fuels for cooking and heating. Epidemiological studies associate household air pollution with lung diseases, including chronic obstructive pulmonary disease, lung cancer, and respiratory infections. Animal dung, a biomass fuel used by economically vulnerable populations, generates more toxic compounds per mass burned than other biomass fuels. The type of animal dung used varies widely depending on local agro-geography. There are currently neither standardized experimental systems for dung biomass smoke research nor studies assessing the health impacts of different types of dung smoke. Here, we used a novel reproducible exposure system to assess outcomes related to inflammation and respiratory infections in human airway cells exposed to six different types of dung biomass smoke. We report that dung biomass smoke, regardless of species, is pro-inflammatory and activates the aryl hydrocarbon receptor and JNK transcription factors; however, dung smoke also suppresses interferon responses after a challenge with a viral mimetic. These effects are consistent with epidemiological data, and suggest a mechanism by which the combustion of animal dung can directly cause lung diseases, promote increased susceptibility to infection, and contribute to the global health problem of household air pollution.

Multifunctional hybrid porous filters with hierarchical structures for simultaneous removal of indoor VOCs, dusts and microorganisms

Air purification often requires multiple layers of filters with different functions to remove various air pollutants, which lead to high pressure drop, high air flow path and frequent filter replacement. In this work, a novel multifunctional Ag@MWCNTs/Al₂O₃ hybrid filter with a depth-type hierarchical structure for simultaneous removal of fine particles, microorganisms and VOCs was designed and fabricated. The novel hybrid air filter showed leading air purification performances to date, achieving 82.24% degradation of formaldehyde at room temperature, 99.99% formaldehyde degradation at 55 °C and complete retention of indoor airborne microorganisms. The complete particle retention rate (100% retention) based on the most penetrating particle size (MPPS, aerodynamic diameter ≦300 nm) of Ag@MWCNTs/Al₂O₃ was achieved at an only 35.60% pressure drop compared with the pristine Al₂O₃ filter, leading to the highest quality factor (Q_f) ever reported. Furthermore, the Ag@MWCNTs/Al₂O₃ hybrid filter showed excellent water repellency (water contact angle of 139.6 ± 2.9°), prolonging the service life of the filters and improving the air purification efficiency. The novel Ag@MWCNTs/Al₂O₃ hybrid filter exhibits remarkable air purification performance in both laboratory synthetic conditions as well as in the "real world" and shows great promise as an effective single replacement for multiple layers of air purifying filters.

Exploring pneumonia risk factors in Vietnamese infants: a survey of new mothers

OBJECTIVE

To understand the prevalence of pneumonia risk factors and perceived barriers to risk factor reduction among Vietnamese infants.

METHODS

We conducted a cross-sectional survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Vietnam from 10 February 2017 to 24 February 2017.

RESULTS

Of 286 mothers surveyed, 259 (91%) initiated breast feeding and 207 (72%) intended to continue exclusive breast feeding for 6 months. No mother smoked cigarettes, but 42% of fathers did. Mothers' decision not to smoke was motivated by concerns for their own health and that of their baby. Households rarely used wood or coal for cooking (6%). Mothers indicated near universal (99%) uptake of the National Expanded Program of Immunization vaccinations. Few (64; 22%) mothers knew about the pneumococcal conjugate vaccine; 56/64 (88%) indicated that they would purchase it for their infants. Family members rarely influenced mothers' decisions about breast feeding or vaccination, except in two instances where fathers were concerned about vaccine-related adverse effects.

CONCLUSION

Modifiable pneumonia risk factors were uncommon among newborn babies in central Vietnam, apart from paternal cigarette smoke exposure. Successful local implementation of the WHO Essential Newborn Care package as well as high levels of maternal education and decision autonomy was observed.

Risk factors for child pneumonia - focus on the Western Pacific Region

Pneumonia is a major cause of disease and death in infants and young children (aged <5 years) globally, as it is in the World Health Organization Western Pacific region. A better understanding of the underlying risk factors associated with child pneumonia is important, since pragmatic primary prevention strategies are likely to achieve major reductions in pneumonia-associated morbidity and mortality in children. This review focuses on risk factors with high relevance to the Western Pacific region, including a lack of exclusive breastfeeding, cigarette smoke and air pollution exposure, malnutrition and conditions of poverty, as well as common co-morbidities. Case management and vaccination coverage have been considered elsewhere.

Dung biomass smoke activates inflammatory signaling pathways in human small airway epithelial cells

Animal dung is a biomass fuel burned by vulnerable populations who cannot afford cleaner sources of energy, such as wood and gas, for cooking and heating their homes. Exposure to biomass smoke is the leading environmental risk for mortality, with over 4,000,000 deaths each year worldwide attributed to indoor air pollution from biomass smoke. Biomass smoke inhalation is epidemiologically associated with pulmonary diseases, including chronic obstructive pulmonary disease (COPD), lung cancer, and respiratory infections, especially in low and middle-income countries. Yet, few studies have examined the mechanisms of dung biomass smoke-induced inflammatory responses in human lung cells. Here, we tested the hypothesis that dung biomass smoke causes inflammatory responses in human lung cells through signaling pathways involved in acute and chronic lung inflammation. Primary human small airway epithelial cells (SAECs) were exposed to dung smoke at the air-liquid interface using a newly developed, automated, and reproducible dung biomass smoke generation system. The examination of inflammatory signaling showed that dung biomass smoke increased the production of several proinflammatory cytokines and enzymes in SAECs through activation of the activator protein (AP)-1 and arylhydrocarbon receptor (AhR) but not nuclear factor-κB (NF-κB) pathways. We propose that the inflammatory responses of lung cells exposed to dung biomass smoke contribute to the development of respiratory diseases.

Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study

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.

Use of Temperature Sensors to Determine Exclusivity of Improved Stove Use and Associated Household Air Pollution Reductions in Kenya

Household air pollution (HAP) contributes to 3.5-4 million annual deaths globally. Recent interventions using improved cookstoves (ICS) to reduce HAP have incorporated temperature sensors as stove use monitors (SUMs) to assess stove use. We deployed SUMs in an effectiveness study of 6 ICSs in 45 Kenyan rural homes. Stove were installed sequentially for 2 weeks and kitchen air monitoring was conducted for 48 h during each 2-week period. We placed SUMs on the ICSs and traditional cookstoves (TCS), and the continuous temperature data were analyzed using an algorithm to examine the number of cooking events, days of exclusive use of ICS, and how stove use patterns affect HAP. Stacking, defined as using both a TCS and an ICS in the same day, occurred on 40% of the study days, and exclusive use of the ICS occurred on 25% of study days. When researchers were not present, ICS use declined, which can have implications for long-term stove adoption in these communities. Continued use of TCSs was also associated with higher HAP levels. SUMs are a valuable tool for characterizing stove use and provide additional information to interpret HAP levels measured during ICS intervention studies.

Household air pollution and the sustainable development goals

Globally, 41% of households, over 2.8 billion people, rely on solid fuels (coal and biomass) for cooking and heating. In developing countries in Asia and sub-Saharan Africa where these fuels are predominantly used, women who are customarily responsible for cooking, and their young children, are most exposed to the resulting air pollution. Solid fuels are still in widespread use and it appears that intervention efforts are not keeping pace with population growth in developing countries. Here we pinpoint the challenges and identify opportunities for addressing household air pollution while mitigating global climate change and promoting the sustainable development goals.

We recommend the following actions: implementation of the WHO indoor air quality guidelineson household fuel combustion; effective promotion and dissemination of improved cookstoves through formation of country alliances for clean cookstoves; expansion of liquefied petroleum gas production facilities and distribution networks; harnessing renewable energy potential; promotion of biogas production at both household and community level; ensuring improved ventilation of homes through education and enforcement of building standards; and exploiting opportunities in the health and other sectors for changing health-damaging cooking behaviour.

Beer, Wood, and Welfare--The Impact of Improved Stove Use Among Dolo-Beer Breweries

Local beer breweries in Burkina Faso absorb a considerable amount of urban woodfuel demand. We assess the woodfuel savings caused by the adoption of improved brewing stoves by these micro-breweries and estimate the implied welfare effects through the woodfuel market on private households as well as the environmental effect. We find substantial wood savings among the breweries, 36% to 38% if they fully switch to an improved stove. In absolute amounts, they save about 0.176 kg of fuelwood per litre of dolo brewed. These savings imply huge reductions in CO₂-emissions and reduce the overall demand for woodfuel, which is predominantly used by the poorer strata for cooking purposes. We provide estimates for the price decrease that might result from this and show that the urban poor are likely to benefit. Thus, the intervention under study is an example for a green growth intervention with pro-poor welfare gains – something green growth strategies should look for.

The intensive margin of technology adoption--Experimental evidence on improved cooking stoves in rural Senegal

Today, almost 3 billion people in developing countries rely on biomass as primary cooking fuel, with profound negative implications for their well-being. Improved biomass cooking stoves are alleged to counteract these adverse effects. This paper evaluates take-up and impacts of low-cost improved stoves through a randomized controlled trial. The randomized stove is primarily designed to curb firewood consumption, but not smoke emissions. Nonetheless, we find considerable effects not only on firewood consumption, but also on smoke exposure and, consequently, smoke-related disease symptoms. The reduced smoke exposure results from behavioural changes in terms of increased outside cooking and a reduction in cooking time. We conclude that in order to assess the effectiveness of a technology-oriented intervention, it is critical to not only account for the incidence of technology adoption - the extensive margin - but also for the way the new technology is used - the intensive margin.

Field testing of alternative cookstove performance in a rural setting of western India

Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs) that are aimed at reducing emissions and fuel consumption. Here, we tested a traditional clay chulha cookstove (TCS) and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1) and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL), in a test kitchen in a rural village of western India. Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5) and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%), which persisted after normalization for fuel consumption or useful energy. PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization (ACSs: 277-714 μg/m³ or 11-28 fold higher than the WHO recommendation of 25 μg/m³).

Piloting improved cookstoves in India

Despite the potential of improved cookstoves to reduce the adverse environmental and health impacts of solid fuel use, their adoption and use remains low. Social marketing-with its focus on the marketing mix of promotion, product, price, and place-offers a useful way to understand household behaviors and design campaigns to change biomass fuel use. We report on a series of pilots across 3 Indian states that use different combinations of the marketing mix. We find sales varying from 0% to 60%. Behavior change promotion that combined door-to-door personalized demonstrations with information pamphlets was effective. When given a choice amongst products, households strongly preferred an electric stove over improved biomass-burning options. Among different stove attributes, reduced cooking time was considered most valuable by those adopting a new stove. Households clearly identified price as a significant barrier to adoption, while provision of discounts (e.g., rebates given if households used the stove) or payments in installments were related to higher purchase. Place-based factors such as remoteness and nongovernmental organization operations significantly affected the ability to supply and convince households to buy and use improved cookstoves. Collectively, these pilots point to the importance of continued and extensive testing of messages, pricing models, and different stove types before scale-up. Thus, we caution that a one-size-fits-all approach will not boost improved cookstove adoption.

Management of NCD in low- and middle-income countries

Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified "best buys" it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases.

Estimating the number of low-income americans exposed to household air pollution from burning solid fuels

BACKGROUND

Exposure to household air pollution (HAP) from inefficient biomass and coal stoves kills nearly 4 million people every year worldwide. HAP is an environmental risk associated with poverty that affects an estimated 3 billion people mostly in low- and middle-income countries.

OBJECTIVES

Our goal was to estimate the number of low-income Americans exposed to potentially health-damaging concentrations of HAP.

METHODS

We mapped county-level data for the percentage of households using wood, coal, and/or coke as their primary heating fuel along with percent of the population below the federal poverty level. Using U.S. Census data and the likelihood of fugitive emissions as reported in the literature, we estimated the number of low-income Americans potentially exposed to HAP.

RESULTS

Solid fuel is the primary heating source for > 2.5 million U.S. households, or 6.5 million people. The mapping exercise showed several rural areas, primarily in the northern and western regions, that have high levels of solid-fuel use and poverty. We then identified 117 counties with high co-incident poverty and solid-fuel use as high-priority counties for research into potential health risks from HAP. We estimate that between 500,000 and 600,000 low-income people in the United States are likely exposed to HAP from burning solid fuels within their homes.

CONCLUSION

HAP occurs within the United States and should be further investigated for adverse health risks, especially among those living in areas with rural poverty.

Urban air pollution and respiratory infections

Public awareness of the impact of air quality on health is increasing worldwide. Indoor and outdoor air pollutants impair children's growing lungs, and increase the risk of respiratory infections. In many cities, children face indoor air pollution from fuels used for cooking and heating, as well as outdoor pollution from vehicle exhausts. Research identifies at-risk groups and seeks to establish biological plausibility for the associations already observed; and looks towards identifying the harmful pollutants that are responsible for respiratory morbidity and mortality. These findings may then serve to influence public debate and future policy at national and international level to improve air quality in cities, and improve children's health.

Source of biomass cooking fuel determines pulmonary response to household air pollution

Approximately 3 billion people-half the worldwide population-are exposed to extremely high concentrations of household air pollution due to the burning of biomass fuels on inefficient cookstoves, accounting for 4 million annual deaths globally. Yet, our understanding of the pulmonary responses to household air pollution exposure and the underlying molecular and cellular events is limited. The two most prevalent biomass fuels in India are wood and cow dung, and typical 24-hour mean particulate matter (PM) concentrations in homes that use these fuels are 300 to 5,000 μg/m(3). We dissected the mechanisms of pulmonary responses in mice after acute or subchronic exposure to wood or cow dung PM collected from rural Indian homes during biomass cooking. Acute exposures resulted in robust proinflammatory cytokine production, neutrophilic inflammation, airway resistance, and hyperresponsiveness, all of which were significantly higher in mice exposed to PM from cow dung. On the contrary, subchronic exposures induced eosinophilic inflammation, PM-specific antibody responses, and alveolar destruction that was highest in wood PM-exposed mice. To understand the molecular pathways that trigger biomass PM-induced inflammation, we exposed Toll-like receptor (TLR)2-, TLR3-, TLR4-, TLR5-, and IL-1R-deficient mice to PM and found that IL-1R, TLR4, and TLR2 are the predominant receptors that elicit inflammatory responses via MyD88 in mice exposed to wood or cow dung PM. In conclusion, this study demonstrates that subchronic exposure to PM collected from households burning biomass fuel elicits a persistent pulmonary inflammation largely through activation of TLR and IL-1R pathways, which could increase the risk for chronic respiratory diseases.

Adjusted effects of domestic violence, tobacco use, and indoor air pollution from use of solid fuel on child mortality

Studies that have separately examined the consequences of gender based violence upon women, use of solid fuel for cooking, and mother and father's use of tobacco on child health have concluded that they serve as risk factors for maternal and child health. Some authors have implied that these studies may have run the risk of overestimating the burden of disease of one factor over another. In this paper, we included all four factors in the same model to estimate their adjusted effects on child mortality, controlling for the demographic factors. The data come from 2005 to 2006 National Family Health Survey of India that interviewed a nationally representative sample of 39,257 couples. Of the four factors, mothers' use of tobacco presented the highest risk for child mortality (OR = 1.42; CI = 1.27-1.60) followed by fathers' use of tobacco (OR = 1.23; CI = 1.12-1.36), households' use of solid fuel for cooking (OR = 1.23; CI = 1.06-1.43), and physical abuse upon mothers (OR = 1.20; CI = 1.10-1.32). Among the households that used solid fuel for cooking, improved cookstoves users experienced 28 % lower odds of child mortality (OR = 0.72; CI = 0.61-0.86) compared to nonusers of improved cookstoves. Additionally, increase in age of mothers at birth of first child, parents' education, and household wealth served as protective factors for child mortality. To prevent child death, programs should focus on reducing couple's use of tobacco, protecting women from physical abuse, and helping households switch from solid to liquid fuel. Moreover, a significant reduction in child death could be attained by improving girls' education, and delaying their age at marriage and first birth.