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

Application of artificial intelligence in quantifying lung deposition dose of black carbon in people with exposure to ambient combustion particles

BACKGROUND

Understanding lung deposition dose of black carbon is critical to fully reconcile epidemiological evidence of combustion particles induced health effects and inform the development of air quality metrics concerning black carbon. Macrophage carbon load (MaCL) is a novel cytology method that quantifies lung deposition dose of black carbon, however it has limited feasibility in large-scale epidemiological study due to the labor-intensive manual counting.

OBJECTIVE

To assess the association between MaCL and episodic elevation of combustion particles; to develop artificial intelligence based counting algorithm for MaCL assay.

METHODS

Sputum slides were collected during episodic elevation of ambient PM2.5 (n = 49, daily PM2.5 > 10 µg/m3 for over 2 weeks due to wildfire smoke intrusion in summer and local wood burning in winter) and low PM2.5 period (n = 39, 30-day average PM2.5 < 4 µg/m3) from the Lovelace Smokers cohort.

RESULTS

Over 98% individual carbon particles in macrophages had diameter <1 µm. MaCL levels scored manually were highly responsive to episodic elevation of ambient PM2.5 and also correlated with lung injury biomarker, plasma CC16. The association with CC16 became more robust when the assessment focused on macrophages with higher carbon load. A Machine-Learning algorithm for Engulfed cArbon Particles (MacLEAP) was developed based on the Mask Region-based Convolutional Neural Network. MacLEAP algorithm yielded excellent correlations with manual counting for number and area of the particles. The algorithm produced associations with ambient PM2.5 and plasma CC16 that were nearly identical in magnitude to those obtained through manual counting.

IMPACT STATEMENT

Understanding lung black carbon deposition is crucial for comprehending health effects of combustion particles. We developed "Machine-Learning algorithm for Engulfed cArbon Particles (MacLEAP)", the first artificial intelligence algorithm for quantifying airway macrophage black carbon. Our study bolstered the algorithm with more training images and its first use in air pollution epidemiology. We revealed macrophage carbon load as a sensitive biomarker for heightened ambient combustion particles due to wildfires and residential wood burning.

Characterization of risks and pathogenesis of respiratory diseases caused by rural atmospheric PM2.5

Forty-six percent of the world's population resides in rural areas, the majority of whom belong to vulnerable groups. They mainly use cheap solid fuels for cooking and heating, which release a large amount of PM2.5 and cause adverse effects to human health. PM2.5 exhibits urban-rural differences in its health risk to the respiratory system. However, the majority of research on this issue has focused on respiratory diseases induced by atmospheric PM2.5 in urban areas, while rural areas have been ignored for a long time, especially the pathogenesis of respiratory diseases. This is not helpful for promoting environmental equity to aid vulnerable groups under PM2.5 pollution. Thus, this study focuses on rural atmospheric PM2.5 in terms of its chemical components, toxicological effects, respiratory disease types, and pathogenesis, represented by PM2.5 from rural areas in the Sichuan Basin, China (Rural SC-PM2.5). In this study, organic carbon is the most significant component of Rural SC-PM2.5. Rural SC-PM2.5 significantly induces cytotoxicity, oxidative stress, and inflammatory response. Based on multiomics, bioinformatics, and molecular biology, Rural SC-PM2.5 inhibits ribonucleotide reductase regulatory subunit M2 (RRM2) to disrupt the cell cycle, impede DNA replication, and ultimately inhibit lung cell proliferation. Furthermore, this study supplements and supports the epidemic investigation. Through an analysis of the transcriptome and human disease database, it is found that Rural SC-PM2.5 may mainly involve pulmonary hypertension, sarcoidosis, and interstitial lung diseases; in particular, congenital diseases may be ignored by epidemiological surveys in rural areas, including tracheoesophageal fistula, submucous cleft of the hard palate, and congenital hypoplasia of the lung. This study contributes to a greater scientific understanding of the health risks posed by rural PM2.5, elucidates the pathogenesis of respiratory diseases, clarifies the types of respiratory diseases, and promotes environmental equity.

Indoor air pollution exposure and early childhood development in the Upstate KIDS Study

BACKGROUND

Limited human studies have investigated the impact of indoor air pollution on early childhood neurodevelopment among the US population. We aimed to examine the associations between prenatal and postnatal indoor air pollution exposure and early childhood development in a population-based birth cohort.

METHODS

This analysis included 4735 mother-child pairs enrolled between 2008 and 2010 in the Upstate KIDS Study. Indoor air pollution exposure from cooking fuels, heating fuels, and passive smoke during pregnancy, and at 12 and 36 months after birth were assessed by questionnaires. Five domains of child development were assessed by the Ages and Stages Questionnaire at 4, 8, 12, 18, 24, 30, and 36 months. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders.

RESULTS

Exposure to unclean cooking fuels (natural gas, propane, or wood) throughout the study period was associated with increased odds of failing any development domain (OR = 1.28, 95% CI 1.07, 1.53), the gross motor domain (OR = 1.52, 95% CI: 1.09, 2.13), and the personal-social domain (OR = 1.36, 95% CI: 1.00, 1.85), respectively. Passive smoke exposure throughout the study period increased the odds of failing the problem-solving domain by 71% (OR = 1.71, 95% CI 1.01, 2.91) among children of non-smoking mothers. No association was found between heating fuel use and failing any or specific domains.

CONCLUSION

Unclean cooking fuel use and passive smoke exposure during pregnancy and early life were associated with developmental delays in this large prospective birth cohort.

Indoor wood-burning from stoves and fireplaces and incident lung cancer among Sister Study participants

BACKGROUND AND AIM

Epidemiological studies conducted mostly in low- and middle-income countries have found a positive association between household combustion of wood and lung cancer. However, most studies have been retrospective, and few have been conducted in the United States where indoor wood-burning usage patterns differ. We examined the association of exposure to indoor wood smoke from fireplaces and stoves with incident lung cancer in a U.S.-wide cohort of women.

METHODS

We included 50,226 women without prior lung cancer participating in the U.S.-based prospective Sister Study. At enrollment (2003-2009), women reported frequency of use of wood-burning stoves and/or fireplaces in their longest-lived adult residence. Cox regression was used to estimate adjusted hazard ratios (HRadj) and 95 % confidence intervals (CI) for the association between indoor wood-burning fireplace/stove use and incident lung cancer. Lung cancer was self-reported and confirmed with medical records.

RESULTS

During an average 11.3 years of follow-up, 347 medically confirmed lung cancer cases accrued. Overall, 62.3 % of the study population reported the presence of an indoor wood-burning fireplace/stove at their longest-lived adult residence and 20.6 % reported annual usage of ≥30 days/year. Compared to those without a wood-burning fireplace/stove, women who used their wood-burning fireplace/stove ≥30 days/year had an elevated rate of lung cancer (HRadj = 1.68; 95 % CI = 1.27, 2.20). In never smokers, positive associations were seen for use 1-29 days/year (HRadj = 1.64; 95 % CI = 0.87, 3.10) and ≥30 days/year (HRadj = 1.99; 95 % CI = 1.02, 3.89). Associations were also elevated across all income groups, in Northeastern, Western or Midwestern U.S. regions, and among those who lived in urban or rural/small town settings.

CONCLUSIONS

Our prospective analysis of a cohort of U.S. women found that increasing frequency of wood-burning indoor fireplace/stove usage was associated with incident lung cancer, even among never smokers.

Mechanisms of Lung Damage and Development of COPD Due to Household Biomass-Smoke Exposure: Inflammation, Oxidative Stress, MicroRNAs, and Gene Polymorphisms

Chronic exposure to indoor biomass smoke from the combustion of solid organic fuels is a major cause of disease burden worldwide. Almost 3 billion people use solid fuels such as wood, charcoal, and crop residues for indoor cooking and heating, accounting for approximately 50% of all households and 90% of rural households globally. Biomass smoke contains many hazardous pollutants, resulting in household air pollution (HAP) exposure that often exceeds international standards. Long-term biomass-smoke exposure is associated with Chronic Obstructive Pulmonary Disease (COPD) in adults, a leading cause of morbidity and mortality worldwide, chronic bronchitis, and other lung conditions. Biomass smoke-associated COPD differs from the best-known cigarette smoke-induced COPD in several aspects, such as a slower decline in lung function, greater airway involvement, and less emphysema, which suggests a different phenotype and pathophysiology. Despite the high burden of biomass-associated COPD, the molecular, genetic, and epigenetic mechanisms underlying its pathogenesis are poorly understood. This review describes the pathogenic mechanisms potentially involved in lung damage, the development of COPD associated with wood-derived smoke exposure, and the influence of genetic and epigenetic factors on the development of this disease.

Do Storage Conditions Affect Collected Cookstove Emission Samples? Implications for Field Studies

Cookstove emissions are a significant source of indoor air pollution in developing countries and rural communities world-wide. Considering that many research sites for evaluating cookstove emissions and interventions are remote and require potentially lengthy periods of particulate matter (PM) filter sample storage in sub-optimal conditions (e.g., lack of cold storage), an important question is whether samples collected in the field are stable over time. To investigate this, red oak was burned in a natural-draft stove, and fine PM (PM2.5) was collected on polytetrafluoroethylene filters. Filters were stored at either ambient temperature or more optimal conditions (-20°C or -80°C) for up to 3 months and extracted. The effects of storage temperature and length on stability were evaluated for measurements of extractable organic matter (EOM), PM2.5, and polycyclic aromatic compound (PAC) levels in the filter extracts. A parallel, controlled laboratory condition was also evaluated to further explore sources of variability. In general, PM2.5 and EOM in both simulated field and laboratory samples were similar regardless of the storage condition or duration. The extracts were also analyzed by gas chromatography to quantify 22 PACs and determine similarities and/or differences between the conditions. PAC levels were a more sensitive stability measure in differentiating between storage conditions. The findings suggest that measurements are relatively consistent across storage duration/temperatures for filter samples with relatively low EOM levels. This study aims to inform protocols and filter storage procedures for exposure and intervention research conducted in low- and middle-income countries where studies may be budget- and infrastructure-limited.

Realistic operation of two residential cordwood-fired outdoor hydronic heater appliances-Part 1: Particulate and gaseous emissions

This study investigated how heat demand and fuel loading affect the emissions from outdoor wood-fired hydronic heaters by testing two such appliances using an integrated-duty cycle test method. This test included transient operating conditions, such as cold and hot-starts and modulation between 15 and 100% of maximum rated output. Emission values indicate transient operating conditions produce higher emissions than steady state operation. Cold starts resulted in elevated particulate matter emission factors for both appliances; in one case the particulate matter emission factor for this period was >3500 mg/MJ, which represented emissions 20 times the average value. Additionally, when heat demand was cycled-elevated CO emission factors were measured, with values >5000 mg/MJ for both appliances and more than 3 times the appliance averages, respectively. It follows that the appliance average particulate matter emission factors and CO emission factors were not representative of the actual EF values during these transient periods. In contrast, methane emission factors were relatively stable throughout all tested combustion conditions; however, they were much higher than oil-fired appliances are therefore should not be ignored. These findings demonstrate that wood-fired hydronic heater emissions during transient operating conditions can be significantly greater than emissions during steady-state test conditions, such as those used in typical certification tests. Consequently, certification test values for particulate matter and CO emission factors may significantly underestimate the actual emissions of these appliances when operated in a home. Use of integrated duty-cycle test protocols that capture cold-starts and reloading are better for representing in-use operations of wood-fired hydronic heaters and provide more realistic emissions and delivered efficiency measurements.Implications: In this work we provide information on the particulate and gaseous emissions from two wood fired outdoor hydronic heaters. The units were tested using an integrated duty cycle test method that captured cold starts, reload, cyclic and modulating periods between 15 and 100% of maximum rated output. The data and results show a much higher emission factor than those reported by current certification test methods but are more representative of how the units operate in the field.

Characterization of in-stack particulate emissions from residential wood hydronic heater appliances under different combustion conditions

In the current work, we provide measurements of size-resolved particle number concentration (PNC), particle mass concentration (PMC), lung-deposited surface area (LDSA), and black carbon (BC) concentration for three biomass fired hydronic heaters during operation in four different combustion conditions. The appliances include one woodchip-fueled hydronic heater and two outdoor cordwood-fueled hydronic heaters. The operating conditions included startup, low output, high output, and burnout. Measurements were made using a custom dilution sampling system and a suite of commercially available, time-resolved, ambient aerosol measurement instrumentation. The PNC, as measured using an Dekati Electrical Low Pressure Impactor+ (ELPI), had operating condition mean values ranging between 4.1 and 52 million particles per cubic centimeter (#/cm³). The highest reported PNC occurred during the startup condition in all cases. Calculating the particle size distribution measured across each operating phase for the same instrument gave geometric mean diameters (d_g) in the range of 0.080-0.256 µm. The largest d_g per appliance was nearly always attributable to the startup condition (for hydronic heater 1, startup d_g ranked second).We did not observe the same trends when we transformed the ELPI PNC to PMC and particle surface area concentration estimates across operating conditions, suggesting PNC and d_g are highly variable. Furthermore, simultaneous measurements of PNC, PMC, and PSAC using instrumentation with different working principles gave varying results, potentially suggesting that particles of different composition and morphology are produced under different combustion conditions.Implications: In this work we compare the results from testing of 3 biomass fired hydronic heaters including one chip-fired appliance and two cordwood-fired appliances. The emissions from these appliances were made across four operating conditions and using three different non-regulatory emissions metrics. This work: describes the difference between chip and cordwood fired units and the effect of operating condition on emissions across the three emissions metrics.

Residential wood heating: An overview of U.S. impacts and regulations

Air pollution from residential wood heating poses a significant public health risk and is a primary cause of PM nonattainment in some areas of the United States. Those emissions also play a role in regional haze and climate change. While regulatory programs have focused on emissions reductions from large facilities, the residential heating sector has received limited attention. The failure to develop effective programs to address this emission source hampers the ability of state and local air quality programs to meet clean air goals. An updated New Source Performance Standard (NSPS) for Residential Wood Heaters was promulgated in 2015, which includes more stringent emissions standards for wood stoves and broadens its scope to regulate additional types of wood heating appliances. However, weaknesses in the test methods and programs used to certify compliance with the NSPS limits hamper the efficacy of those requirements. Current emissions certification tests measure stove performance under defined laboratory conditions that (1) do not adequately reflect operation and performance of appliances in homes, (2) are not sufficiently repeatable to allow for comparison of emissions of different appliances, and (3) allow manufacturers leeway to modify critical test fueling and operating parameters which can significantly impact performance outcomes. These foundational regulatory issues present substantial challenges to promoting the cleanest and most efficient wood heating systems. This paper provides an overview of the air quality and public health impacts of residential wood heating and discusses the weaknesses in the current emission certification approaches and work by the Northeast States for Coordinated Air Use Management (NESCAUM) and the New York State Energy Research and Development Authority to develop improved testing methods. Other articles in this issue discuss the development and testing of those methods in detail.Implications: Air pollution from residential wood heating poses a significant public health risk and is a primary cause of PM nonattainment in some areas of the United States. Those emissions also play a role in regional haze and climate change. While regulatory programs have focused on emissions reductions from large facilities, the residential heating sector has received limited attention. The failure to develop effective programs to address this emission source hampers the ability of state and local air quality programs to meet clean air goals. This paper provides an overview of the issue.

The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: An Analysis of Statewide Hospital Discharge Data

Purpose

Individuals in rural areas of the United States have a greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties.

Methods

We examined differences in COPD exacerbation rates ([encounters per county/county population of 35 years of age and older] × 100), length of stay (LOS), and total charges by rurality, determined by the 2013 National Center for Health Statistics rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence.

Findings

A total of 15,916 encounters were analyzed, of which 5805 were inpatient and 10,111 were from the emergency department, 7058 (44%) were male, and the mean age was 65.6. A total of 31% were from large, fringe metro counties, 25.9% were from medium metro counties, 37.6% were from micropolitan counties, and 5.5% were from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties (non-core beta=0.18, [confidence interval (CI) 0.16, 0.20]; micropolitan beta=0.02, CI [0.01, 0.03]); medium metro counties (beta=-0.07, Cl [-0.09, -0.06]) had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta=-1695 [-2410, -980]; micropolitan beta=-2701 [-3315, -2088]; non-core beta=-4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality.

Conclusions

Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural versus non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.

Household and behavioral determinants of indoor PM2.5 in a rural solid fuel burning Native American community

Indoor and outdoor concentrations of PM_2.5 were measured for 24 h during heating and non-heating seasons in a rural solid fuel burning Native American community. Household building characteristics were collected during the initial home sampling visit using technician walkthrough questionnaires, and behavioral factors were collected through questionnaires by interviewers. To identify seasonal behavioral factors and household characteristics associated with indoor PM_2.5 , data were analyzed separately by heating and non-heating seasons using multivariable regression. Concentrations of PM_2.5 were significantly higher during the heating season (indoor: 36.2 μg/m³ ; outdoor: 22.1 μg/m³ ) compared with the non-heating season (indoor: 14.6 μg/m³ ; outdoor: 9.3 μg/m³ ). Heating season indoor PM_2.5 was strongly associated with heating fuel type, housing type, indoor pests, use of a climate control unit, number of interior doors, and indoor relative humidity. During the non-heating season, different behavioral and household characteristics were associated with indoor PM_2.5 concentrations (indoor smoking and/or burning incense, opening doors and windows, area of surrounding environment, building size and height, and outdoor PM_2.5 ). Homes heated with coal and/or wood, or a combination of coal and/or wood with electricity and/or natural gas had elevated indoor PM_2.5 concentrations that exceeded both the EPA ambient standard (35 μg/m³ ) and the WHO guideline (25 μg/m³ ).

Toward Clean Residential Energy: Challenges and Priorities in Research

Solid fuels used for cooking, heating, and lighting are major emission sources of many air pollutants, specifically PM_2.5 and black carbon, resulting in adverse environmental and health impacts. At the same time, the transition from using residential solid fuels toward using cleaner energy sources can result in significant health benefits. Here, we briefly review recent research progress on the emissions of air pollutants from the residential sector and the impacts of emissions on ambient and indoor air quality, population exposure, and health consequences. The major challenges and future research priorities are identified and discussed.

Indoor Air Pollution and Respiratory Health

Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor air pollution, their respiratory health effects, and strategies to reduce household pollution and improve lung health across the globe.

Rural Residence and Poverty Are Independent Risk Factors for Chronic Obstructive Pulmonary Disease in the United States

RATIONALE

In developing countries, poor and rural areas have a high burden of chronic obstructive pulmonary disease (COPD), and environmental pollutants and indoor burning of biomass have been implicated as potential causal exposures. Less is known about the prevalence of COPD in the United States with respect to urban-rural distribution, poverty, and factors that uniquely contribute to COPD among never-smokers.

OBJECTIVES

To understand the impact of urban-rural status, poverty, and other community factors on COPD prevalence nationwide and among never-smokers.

METHODS

We studied a nationally representative sample of adults in the National Health Interview Survey 2012-2015, with data linkage between neighborhood data from the U.S. Census's American Community Survey and the National Center for Health Statistics Urban-Rural Classification Scheme. The main outcome was COPD prevalence.

MEASUREMENTS AND MAIN RESULTS

The prevalence of COPD in poor, rural areas was almost twice that in the overall population (15.4% vs. 8.4%). In adjusted models, rural residence (odds ratio [OR], 1.23; P < 0.001) and census-level poverty (OR, 1.12; P = 0.012) were both associated with COPD prevalence, as were indicators of household wealth. Among never-smokers, rural residence was also associated with COPD (OR, 1.34; P < 0.001), as was neighborhood use of coal for heating (OR, 1.09; P < 0.001).

CONCLUSIONS

In a nationally representative sample, rural residence and poverty were risk factors for COPD, even among never-smokers. The use of coal for heating was also a risk factor for COPD among never-smokers. Future disparities research to elucidate contributors to COPD development in poor and rural areas, including assessments of heating sources and environmental pollutants, is needed.

The establishment of the Household Air Pollution Consortium (HAPCO)

Household air pollution (HAP) is of public health concern with ~3 billion people worldwide (including >15 million in the US) exposed. HAP from coal use is a human lung carcinogen, yet the epidemiological evidence on carcinogenicity of HAP from biomass use, primarily wood, is not conclusive. To robustly assess biomass's carcinogenic potential, prospective studies of individuals experiencing a variety of HAP exposures are needed. We have built a global consortium of 13 prospective cohorts (HAPCO: Household Air Pollution Consortium) that have site- and disease-specific mortality and solid fuel use data, for a combined sample size of 587,257 participants and 57,483 deaths. HAPCO provides a novel opportunity to assess the association of HAP with lung cancer death while controlling for important confounders such as tobacco and outdoor air pollution exposures. HAPCO is also uniquely positioned to determine the risks associated with cancers other than lung as well as non-malignant respiratory and cardiometabolic outcomes, for which prospective epidemiologic research is limited. HAPCO will facilitate research to address public health concerns associated with HAP-attributed exposures by enabling investigators to evaluate sex-specific and smoking status-specific effects under various exposure scenarios.

The role of environmental exposure to non-cigarette smoke in lung disease

Chronic exposure to household indoor smoke and outdoor air pollution is a major contributor to global morbidity and mortality. The majority of these deaths occur in low and middle-income countries. Children, women, the elderly and people with underlying chronic conditions are most affected. In addition to reduced lung function, children exposed to biomass smoke have an increased risk of developing lower respiratory tract infections and asthma-related symptoms. In adults, chronic exposure to biomass smoke, ambient air pollution, and opportunistic exposure to fumes and dust are associated with an increased risk of developing chronic bronchitis, chronic obstructive pulmonary disease (COPD), lung cancer and respiratory infections, including tuberculosis. Here, we review the evidence of prevalence of COPD in people exposed to non-cigarette smoke. We highlight mechanisms that are likely involved in biomass-smoke exposure-related COPD and other lung diseases. Finally, we summarize the potential preventive and therapeutic strategies for management of COPD induced by non-cigarette smoke exposure.

Chronic bronchitis and airflow obstruction is associated with household cooking fuel use among never-smoking women: a community-based cross-sectional study in Odisha, India

BACKGROUND

The use of solid biomass as cooking fuel could be a potential risk factor for chronic bronchitis (CB) and airflow obstruction (AFO) among never-smoking women. The disease burden in India among women is generally underestimated due to limited population-based epidemiological investigations. The aim of the study was to determine the prevalence of CB and AFO among never-smoking women, and its association with household cooking fuel use.

METHODS

We conducted a community-based cross-sectional study with a representative study sample (N = 1120) in Odisha, India during 2013-14. Study participants, never-smoking women aged 18-49 years, were recruited randomly from the population census. Trained community health volunteers administered a validated questionnaire that aligned with the standards of the Burden of Obstructive Lung Disease (BOLD) initiative and conducted spirometry. Prevalence estimates of CB (defined as "cough with productive of sputum for at least 3 months of the year for at least 2 years") and AFO (pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7) was estimated. Indoor PM2.5 exposure data were collected from a subset of 130 of the total 1120 homes in the study settings. Multivariable regression models were used to estimate the associated risk factors.

RESULTS

Prevalence of CB and AFO were 7.3 and 22.4% respectively among the study participants. Of the study participants, 31% used exclusive liquefied petroleum gas, 18% used mixed fuel and 51% exclusively used solid biomass fuel for household cooking. In adjusted analysis, both CB (odds ratio 1·96, 95% CI: 1.06-3.64; p = 0·031) and AFO (OR 5.55, 95% CI: 3.51-8.78; p < 0·001) were found to be associated with cooking with solid biomass fuel. Interquartile range increases in PM2.5 was associated with significantly lower FEV1/FVC ratio.

CONCLUSIONS

The study highlights that the estimates of population burden of CB and AFO are much higher than shown in previous epidemiological studies, and that cooking fuel type and time spent on cooking were associated with increased chronic bronchitis as well as decreased lung function as measured by FEV1/FCV ratios. To most accurately understand the current burden of disease and most effectively prevent an escalation in the future disease burden, further epidemiological investigations are warranted.

Low-cost measurement techniques to characterize the influence of home heating fuel on carbon monoxide in Navajo homes

A large fraction of the global population relies on the inefficient combustion of solid fuels for cooking and home heating, resulting in household exposure to combustion byproducts. In the southwestern United States, unhealthy air quality has been observed in some homes that use solid fuels as a primary source of heat on the Navajo Nation. In order to better understand how home heating fuel choice can influence indoor air quality in this region, we used recently developed low-cost electrochemical sensors to measure carbon monoxide (CO) air mole fractions continuously inside and outside 41 homes in two communities on the Navajo Nation. Using low-cost sensors in this study, which don't require extensive training to operate, enabled collaboration with local Diné College students and faculty in the planning and implementation of home deployments. Households used natural gas, propane, pellets, wood, and/or coal for heating. We developed quantification methods that included uncertainty estimation for Alphasense CO-B4 sensors, for measurements both inside and outside homes. CO concentrations elevated above background were observed in homes in each heating fuel group, but the highest hourly concentrations were observed in wood and coal burning homes, some of which exceeded World Health Organization Guidelines on both an hourly and eight-hourly basis. In order to probe the many factors that can influence indoor pollutant concentrations, we developed and implemented methods that employ CO emission and decay time periods observed in homes during everyday activities to estimate air exchange rates as well as CO emission rates on the basis of a given well-mixed volume of air. The air quality measurement tools and methods demonstrated in this study can be readily extended to indoor air quality studies in other communities around the world to inform how home heating and cooking practices are influencing indoor air quality during normal daily activities.

Quantifying the Contribution to Uncertainty in Mortality Attributed to Household, Ambient, and Joint Exposure to PM2.5 From Residential Solid Fuel Use

While there have been substantial efforts to quantify the health burden of exposure to PM_2.5 from solid fuel use (SFU), the sensitivity of mortality estimates to uncertainties in input parameters has not been quantified. Moreover, previous studies separate mortality from household and ambient air pollution. In this study, we develop a new estimate of mortality attributable to SFU due to the joint exposure from household and ambient PM_2.5 pollution and perform a variance-based sensitivity analysis on mortality attributable to SFU. In the joint exposure calculation, we estimate 2.81 (95% confidence interval: 2.48-3.28) million premature deaths in 2015 attributed to PM_2.5 from SFU, which is 580,000 (18%) fewer deaths than would be calculated by summing separate household and ambient mortality calculations. Regarding the sources of uncertainties in these estimates, in China, India, and Latin America, we find that 53-56% of the uncertainty in mortality attributable to SFU is due to uncertainty in the percent of the population using solid fuels and 42-50% from the concentration-response function. In sub-Saharan Africa, baseline mortality rate (72%) and the concentration-response function (33%) dominate the uncertainty space. Conversely, the sum of the variance contributed by ambient and household PM_2.5 exposure ranges between 15 and 38% across all regions (the percentages do not sum to 100% as some uncertainty is shared between parameters). Our findings suggest that future studies should focus on more precise quantification of solid fuel use and the concentration-response relationship to PM_2.5, as well as mortality rates in Africa.

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.

Emission factors of fine particulate matter, organic and elemental carbon, carbon monoxide, and carbon dioxide for four solid fuels commonly used in residential heating by the U.S. Navajo Nation

Most homes in the Navajo Nation use wood as their primary heating fuel, often in combination with locally mined coal. Previous studies observed health effects linked to this solid-fuel use in several Navajo communities. Emission factors (EFs) for common fuels used by the Navajo have not been reported using a relevant stove type. In this study, two softwoods (ponderosa pine and Utah juniper) and two high-volatile bituminous coals (Black Mesa and Fruitland) were tested with an in-use residential conventional wood stove (homestove) using a modified American Society for Testing and Materials/U.S. Environmental Protection Agency (ASTM/EPA) protocol. Filter sampling quantified PM_2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm) and organic (OC) and elemental (EC) carbon in the emissions. Real-time monitoring quantified carbon monoxide (CO), carbon dioxide (CO₂), and total suspended particles (TSP). EFs for these air pollutants were developed and normalized to both fuel mass and energy consumed. In general, coal had significantly higher mass EFs than wood for all pollutants studied. In particular, coal emitted, on average, 10 times more PM_2.5 than wood on a mass basis, and 2.4 times more on an energy basis. The EFs developed here were based on fuel types, stove design, and operating protocols relevant to the Navajo Nation, but they could be useful to other Native Nations with similar practices, such as the nearby Hopi Nation.

IMPLICATIONS

Indoor wood and coal combustion is an important contributor to public health burdens in the Navajo Nation. Currently, there exist no emission factors representative of Navajo homestoves, fuels, and practices. This study developed emission factors for PM_2.5, OC, EC, CO, and CO₂ using a representative Navajo homestove. These emission factors may be utilized in regional-, national-, and global-scale health and environmental models. Additionally, the protocols developed and results presented here may inform on-going stove design of the first EPA-certified wood and coal combination stove.

Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries

Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.

Systematic identification and prioritization of communities impacted by residential woodsmoke in British Columbia, Canada

Residential woodsmoke is an under-regulated source of fine particulate matter (PM_2.5), often surpassing mobile and industrial emissions in rural communities in North America and elsewhere. In the province of British Columbia (BC), Canada, many municipalities are hesitant to adopt stricter regulations for residential wood burning without empirical evidence that smoke is affecting local air quality. The objective of this study was to develop a retrospective algorithm that uses 1-h PM_2.5 concentrations and daily temperature data to identify smoky days in order to prioritise communities by smoke impacts. Levoglucosan measurements from one of the smokiest communities were used to establish the most informative values for three algorithmic parameters: the daily standard deviation of 1-h PM_2.5 measurements; the daily mean temperature; and the daytime-to-nighttime ratio of PM_2.5 concentrations. Alternate parameterizations were tested in 45 sensitivity analyses. Using the most informative parameter values on the most recent two years of data for each community, the number of smoky days ranged from 5 to 277. Heat maps visualizing seasonal and diurnal variation in PM_2.5 concentrations showed clear differences between the higher- and lower-ranked communities. Some communities were sensitive to one or more of the parameters, but the overall rankings were consistent across the 45 analyses. This information will allow stakeholder agencies to work with local governments on implementing appropriate intervention strategies for the most smoke-impacted communities.

Antimüllerian hormone in relation to tobacco and marijuana use and sources of indoor heating/cooking

OBJECTIVE

To evaluate exposure to tobacco, marijuana, and indoor heating/cooking sources in relation to antimüllerian hormone (AMH) levels.

DESIGN

Cross-sectional analysis in a sample of premenopausal women (n = 913) enrolled in the Sister Study cohort (n = 50,884).

SETTING

Not applicable.

PATIENT(S)

Women, ages 35-54 years at time of enrollment, with an archived serum sample and at least one intact ovary and classified as premenopausal.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Serum AMH (ng/mL) levels ascertained by ultrasensitive ELISA assay.

RESULT(S)

Lower AMH levels were associated with sources of indoor heating, including burning wood (-36.0%; 95% confidence interval [CI], -55.7%, -7.8%) or artificial fire logs (-45.8%; 95% CI, -67.2%, -10.4%) at least 10 times/year in a residential indoor stove/fireplace. Lower AMH levels were also observed in women who were current smokers of ≥20 cigarettes/day relative to nonsmokers (-56.2%; 95% CI, -80.3%, -2.8%) and in women with 10+ years of adult environmental tobacco smoke (ETS) exposure (-31.3%; 95% CI, -51.3%, -3.1%), but no associations were observed for marijuana use.

CONCLUSION(S)

We confirmed previously reported findings of lower AMH levels in current heavy smokers and also found associations for long-term ETS exposure and indoor burning of wood or artificial fire logs. These findings suggest that combustion by-products from common exposures can have toxic effects on the human ovary.

Mutagenicity and Pollutant Emission Factors of Solid-Fuel Cookstoves: Comparison with Other Combustion Sources

BACKGROUND

Emissions from solid fuels used for cooking cause ~4 million premature deaths per year. Advanced solid-fuel cookstoves are a potential solution, but they should be assessed by appropriate performance indicators, including biological effects.

OBJECTIVE

We evaluated two categories of solid-fuel cookstoves for eight pollutant and four mutagenicity emission factors, correlated the mutagenicity emission factors, and compared them to those of other combustion emissions.

METHODS

We burned red oak in a 3-stone fire (TSF), a natural-draft stove (NDS), and a forced-draft stove (FDS), and we combusted propane as a liquified petroleum gas control fuel. We determined emission factors based on useful energy (megajoules delivered, MJd) for carbon monoxide, nitrogen oxides (NOx), black carbon, methane, total hydrocarbons, 32 polycyclic aromatic hydrocarbons, PM2.5, levoglucosan (a wood-smoke marker), and mutagenicity in Salmonella.

RESULTS

With the exception of NOx, the emission factors per MJd were highly correlated (r ≥ 0.97); the correlation for NOx with the other emission factors was 0.58-0.76. Excluding NOx, the NDS and FDS reduced the emission factors an average of 68 and 92%, respectively, relative to the TSF. Nevertheless, the mutagenicity emission factor based on fuel energy used (MJthermal) for the most efficient stove (FDS) was between those of a large diesel bus engine and a small diesel generator.

CONCLUSIONS

Both mutagenicity and pollutant emission factors may be informative for characterizing cookstove performance. However, mutagenicity emission factors may be especially useful for characterizing potential health effects and should be evaluated in relation to health outcomes in future research. An FDS operated as intended by the manufacturer is safer than a TSF, but without adequate ventilation, it will still result in poor indoor air quality.

CITATION

Mutlu E, Warren SH, Ebersviller SM, Kooter IM, Schmid JE, Dye JA, Linak WP, Gilmour MI, Jetter JJ, Higuchi M, DeMarini DM. 2016. Mutagenicity and pollutant emission factors of solid-fuel cookstoves: comparison with other combustion sources. Environ Health Perspect 124:974-982; http://dx.doi.org/10.1289/ehp.1509852.

Cancer prevention as part of precision medicine: 'plenty to be done'

Cancer burden worldwide is projected to rise from 14 million new cases in 2012 to 24 million in 2035. Although the greatest increases will be in developing countries, where cancer services are already hard pressed, even the richest nations will struggle to meet demands of increasing patient numbers and spiralling treatment costs. No country can treat its way out of the cancer problem. Consequently, cancer control must combine improvements in treatment with greater emphasis on prevention and early detection. Cancer prevention is founded on describing the burden of cancer, identifying the causes and evaluating and implementing preventive interventions. Around 40-50% of cancers could be prevented if current knowledge about risk factors was translated into effective public health strategies. The benefits of prevention are attested to by major successes, for example, in tobacco control, vaccination against oncogenic viruses, reduced exposure to environmental and occupational carcinogens, and screening. Progress is still needed in areas such as weight control and physical activity. Fresh impetus for prevention and early detection will come through interdisciplinary approaches, encompassing knowledge and tools from advances in cancer biology. Examples include mutation profiles giving clues about aetiology and biomarkers for early detection, to stratify individuals for screening or for prognosis. However, cancer prevention requires a broad perspective stretching from the submicroscopic to the macropolitical, recognizing the importance of molecular profiling and multisectoral engagement across urban planning, transport, environment, agriculture, economics, etc., and applying interventions that may just as easily rely on a legislative measure as on a molecule.

Is air pollution a risk factor for rheumatoid arthritis?

Rheumatoid arthritis is a chronic inflammatory debilitating disease triggered by a complex interaction involving genetic and environmental factors. Active smoking and occupational exposures such as silica increase its risk, suggesting that initial inflammation and generation of rheumatoid arthritis-related autoantibodies in the lungs may precede the clinical disease. This hypothesis paved the way to epidemiological studies investigating air pollution as a potential determinant of rheumatoid arthritis. Studies designed for epidemiology of rheumatoid arthritis found a link between traffic, a surrogate of air pollution, and this disease. Furthermore, a small case–control study recently found an association between wood smoke exposure and anticyclic citrullinated protein/peptide antibody in sera of patients presenting wood-smoke-related chronic obstructive pulmonary disease. However, reports addressing impact of specific pollutants on rheumatoid arthritis incidence and severity across populations are somewhat conflicting. In addition to the link reported between other systemic autoimmune rheumatic diseases and particulate matters/gaseous pollutants, experimental observation of exacerbated rheumatoid arthritis incidence and severity in mice models of collagen-induced arthritis after diesel exhaust particles exposure as well as hypovitaminosis D-related autoimmunity can help understand the role of air pollution in rheumatoid arthritis. All these considerations highlight the necessity to extend high quality epidemiological researches investigating different sources of atmospheric pollution across populations and particularly in low-and-middle countries, in order to further explore the biological plausibility of air pollution’s effect in the pathogenesis of rheumatoid arthritis. This should be attempted to better inform policies aiming to reduce the burden of rheumatoid arthritis.

Indoor particulate matter in rural, wood stove heated homes

Ambient particulate matter (PM) exposures have adverse impacts on public health, but research evaluating indoor PM concentrations in rural homes in the United States using wood as fuel for heating is limited. Our objectives were to characterize indoor PM mass and particle number concentrations (PNCs), quantify infiltration of outdoor PM into the indoor environment, and investigate potential predictors of concentrations and infiltration in 96 homes in the northwestern US and Alaska using wood stoves as the primary source of heating. During two forty-eight hour sampling periods during the pre-intervention winter of a randomized trial, we assessed PM mass (<2.5μm) and PNCs (particles/cm(3)) in six size fractions (0.30-0.49, 0.50-0.99, 1.00-2.49, 2.5-5.0, 5.0-10.0, 10.0+μm). Daily mean (sd) PM2.5 concentrations were 28.8 (28.5)μg/m(3) during the first sampling period and 29.1 (30.1)μg/m(3) during the second period. In repeated measures analyses, household income was inversely associated with PM2.5 and smaller size fraction PNCs, in particular. Time of day was a significant predictor of indoor and outdoor PM2.5 concentrations, and infiltration efficiency was relatively low (Finf (sd)=0.27 (0.20)). Our findings demonstrate relatively high mean PM concentrations in these wood burning homes and suggest potential targets for interventions for improving indoor air quality and health in rural settings.

Indoor air pollution exposure from use of indoor stoves and fireplaces in association with breast cancer: a case-control study

BACKGROUND

Previous studies suggest that polycyclic aromatic hydrocarbons (PAHs) may adversely affect breast cancer risk. Indoor air pollution from use of indoor stoves and/or fireplaces is an important source of ambient PAH exposure. However, the association between indoor stove/fireplace use and breast cancer risk is unknown. We hypothesized that indoor stove/fireplace use in a Long Island, New York study population would be positively associated with breast cancer and differ by material burned, and the duration and timing of exposure. We also hypothesized that the association would vary by breast cancer subtype defined by p53 mutation status, and interact with glutathione S-transferases GSTM1, T1, A1 and P1 polymorphisms.

METHODS

Population-based, case-control resources (1,508 cases/1,556 controls) were used to conduct unconditional logistic regression to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Breast cancer risk was increased among women reporting ever burning synthetic logs (which may also contain wood) in their homes (OR = 1.42, 95% CI 1.11, 1.84), but not for ever burning wood alone (OR = 0.93, 95% CI 0.77, 1.12). For synthetic log use, longer duration >7 years, older age at exposure (>20 years; OR = 1.65, 95% CI 1.02, 2.67) and 2 or more variants in GSTM1, T1, A1 or P1 (OR = 1.71, 95% CI 1.09, 2.69) were associated with increased risk.

CONCLUSIONS

Burning wood or synthetic logs are both indoor PAH exposure sources; however, positive associations were only observed for burning synthetic logs, which was stronger for longer exposures, adult exposures, and those with multiple GST variant genotypes. Therefore, our results should be interpreted with care and require replication.