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Williams KN, Kamenar K, Kephart JL, Chiang M, Hartinger SM, Checkley W. Testing the effectiveness of household fuel conservation strategies: Policy implications for increasing the affordability of exclusive clean cooking. ENVIRONMENT INTERNATIONAL 2023; 180:108223. [PMID: 37748372 PMCID: PMC10732248 DOI: 10.1016/j.envint.2023.108223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Exclusive clean fuel use is essential for realizing health and other benefits but is often unaffordable. Decreasing household-level fuel needs could make exclusive clean fuel use more affordable, but there is a lack of knowledge on the amount of fuel savings that could be achieved through fuel conservation behaviors relevant to rural settings in low- and middle-income countries. METHODS Within a trial in Peru, we trained a random half of intervention participants, who had previously received a liquefied petroleum gas (LPG) stove and were purchasing their own fuel, on fuel conservation strategies. We measured the amount of fuel and mega joules (MJ) of energy consumed by all participants, including control participants who were receiving free fuel from the trial. We administered surveys on fuel conservation behaviors and assigned a score based on the number of behaviors performed. RESULTS Intervention participants with the training had a slightly higher conservation score than those without (7.2 vs. 6.6 points; p = 0.07). Across all participants, average daily energy consumption decreased by 9.5 MJ for each 1-point increase in conservation score (p < 0.001). Among households who used exclusively LPG (n = 99), each 1-point increase in conservation score was associated with a 0.04 kg decrease in LPG consumption per household per day (p = 0.03). Using pressure cookers and heating water in the sun decreased energy use, while using clay pots and forgetting to close stove knobs increased energy use. CONCLUSION Our findings suggest that a household could save 1.16 kg of LPG per month for each additional fuel conservation behavior, for a maximum potential savings of 8.1 kg per month. Fuel conservation messaging could be integrated into national household energy policies to increase the affordability of exclusive clean fuel use, and subsequently achieve the environmental and health benefits that could accompany such a transition.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Katarina Kamenar
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Stella M Hartinger
- Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Williams KN, Quinn A, North H, Wang J, Pillarisetti A, Thompson LM, Díaz-Artiga A, Balakrishnan K, Thangavel G, Rosa G, Ndagijimana F, Underhill LJ, Kirby MA, Puzzolo E, Hossen S, Waller LA, Peel JL, Rosenthal JP, Clasen TF, Harvey SA, Checkley W. Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial. ENVIRONMENT INTERNATIONAL 2023; 179:108160. [PMID: 37660633 PMCID: PMC10512198 DOI: 10.1016/j.envint.2023.108160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels. METHODS The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n = 1,590), with controls expected to continue cooking with biomass fuels (n = 1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs). RESULTS Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0-2). Although 26% (n = 410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove < 1 day per month. Traditional stove use was slightly higher post-COVID-19 (detected on a median [Q1, Q3] of 0.0% [0.0%, 3.4%] of days) than pre-COVID-19 (0.0% [0.0%, 1.6%] of days). There was no significant difference in intervention adherence pre- and post-birth. CONCLUSION Free stoves and an unlimited supply of LPG fuel delivered to participating homes combined with timely repairs, behavioral messaging, and comprehensive stove use monitoring contributed to high intervention fidelity and near-exclusive LPG use within the HAPIN trial.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hayley North
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, CA, USA
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Gurusamy Thangavel
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Lindsay J Underhill
- Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Miles A Kirby
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Puzzolo
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua P Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Williams KN, Quinn A, North H, Wang J, Pillarisetti A, Thompson LM, Díaz-Artiga A, Balakrishnan K, Thangavel G, Rosa G, Ndagijimana F, Underhill LJ, Kirby MA, Puzzolo E, Hossen S, Waller LA, Peel JL, Rosenthal JP, Clasen TF, Harvey SA, Checkley W. Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: the multi-country Household Air Pollution Intervention Network (HAPIN) trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.20.23291670. [PMID: 37425899 PMCID: PMC10327189 DOI: 10.1101/2023.06.20.23291670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels. Methods The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n=1,590), with controls expected to continue cooking with biomass fuels (n=1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs). Results Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0-2). Although 26% (n=410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove <1 day per month. Traditional stove use was slightly higher post-COVID-19 (detected on a median [Q1, Q3] of 0.0% [0.0%, 3.4%] of days) than pre-COVID-19 (0.0% [0.0%, 1.6%] of days). There was no significant difference in intervention adherence pre- and post-birth. Conclusion Free stoves and an unlimited supply of LPG fuel delivered to participating homes combined with timely repairs, behavioral messaging, and comprehensive stove use monitoring contributed to high intervention fidelity and near-exclusive LPG use within the HAPIN trial.
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Affiliation(s)
- Kendra N. Williams
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hayley North
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, CA, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Gurusamy Thangavel
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Lindsay J. Underhill
- Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Puzzolo
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua P. Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven A. Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Williams KN, Kephart JL, Fandiño-Del-Rio M, Nicolaou L, Koehler K, Harvey SA, Checkley W. Sustained use of liquefied petroleum gas following one year of free fuel and behavioral support in Puno, Peru. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2023; 73:13-22. [PMID: 36798733 PMCID: PMC9928150 DOI: 10.1016/j.esd.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Existing efforts to promote cleaner fuels have not achieved exclusive use. We investigated whether receiving 12 months of free liquefied petroleum gas (LPG) and behavioral support could motivate continued purchase and use. Methods The Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial enrolled 180 women. Half were randomly assigned to an intervention group, which included free LPG delivered in months 1-12 followed by a post-intervention period in which they no longer received free fuel (months 13-24). For the purposes of comparison, we also include months 1-12 of data from control participants. We tracked stove use with temperature monitors, surveys, and observations, and conducted in-depth interviews with 19 participants from the intervention group at the end of their post-intervention period. Results Participants from the intervention group used their LPG stove for 85.4 % of monitored days and 63.2 % of cooking minutes during the post-intervention months (13-24) when they were not receiving free fuel from the trial. They used a traditional stove (fogón) on 45.1 % of days post-intervention, which is significantly lower than fogón use by control participants during the intervention period (72.2 % of days). In months 13-24 post-intervention, participants from the intervention group purchased on average 12.3 kg and spent 34.1 soles (10.3 USD) per month on LPG. Continued LPG use was higher among participants who said they could afford two tanks of LPG per month, did not cook for animals, and removed their traditional stove. Women described that becoming accustomed to LPG, support and training from the project, consistent LPG supply, choice between LPG providers, and access to delivery services facilitated sustained LPG use. However, high cost was a major barrier to exclusive use. Conclusion A 12-month period of intensive LPG support achieved a high level of sustained LPG use post-intervention, but other strategies are needed to sustain exclusive use.
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Affiliation(s)
- Kendra N. Williams
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L. Kephart
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A. Harvey
- Department of International Health, Social and Behavioral Interventions Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Ye W, Pillarisetti A, de León O, Steenland K, Peel JL, Clark ML, Checkley W, Underhill LJ, Quinn A, Balakrishnan K, Garg SS, McCracken JP, Thompson LM, Díaz-Artiga A, Rosa G, Davila-Roman VG, de las Fuentes L, Papageorghiou AT, Chen Y, Wang J, Thomas FC. Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.23.23284847. [PMID: 36747716 PMCID: PMC9901046 DOI: 10.1101/2023.01.23.23284847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study. We assessed associations between PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm), BC (black carbon), and CO (carbon monoxide) exposures and blood pressure at baseline, prior to intervention, among 3195 pregnant women between 9 and 19 weeks of gestation. We measured 24-hour personal exposure to PM2.5/BC/CO and gestational blood pressure. Multivariable linear regression models were used to evaluate associations between personal exposures to three air pollutants and blood pressure parameters. Trial-wide, we found moderate increases in systolic blood pressure (SBP) and decreases in diastolic blood pressure (DBP) as exposure to PM2.5, BC, and CO increased. None of these associations, however, were significant at the 0.05 level. HAP exposure and blood pressure associations were inconsistent in direction and magnitude within each country. We observed effect modification by body mass index (BMI) in India and Peru. Compared to women with normal weights, obese women in India and Peru (but not in Rwanda or Guatemala) had higher SBP per unit increase in log transformed PM2.5 and BC exposures. We did not find a cross-sectional association between HAP exposure and blood pressure in pregnant women; however, HAP may be associated with higher blood pressure in pregnant women who are obese, but this increase was not consistent across settings.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Oscar de León
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lindsay J. Underhill
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, California, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada S. Garg
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - John P. McCracken
- Global Health Institute, Collage of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lisa de las Fuentes
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Shen G, Xiong R, Tian Y, Luo Z, Jiangtulu B, Meng W, Du W, Meng J, Chen Y, Xue B, Wang B, Duan Y, Duo J, Fan F, Huang L, Ju T, Liu F, Li S, Liu X, Li Y, Wang M, Nan Y, Pan B, Pan Y, Wang L, Zeng E, Zhan C, Chen Y, Shen H, Cheng H, Tao S. Substantial transition to clean household energy mix in rural China. Natl Sci Rev 2022; 9:nwac050. [PMID: 35854783 PMCID: PMC9283105 DOI: 10.1093/nsr/nwac050] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/14/2022] Open
Abstract
The household energy mix has significant impacts on human health and climate, as it contributes greatly to many health- and climate-relevant air pollutants. Compared to the well-established urban energy statistical system, the rural household energy statistical system is incomplete and is often associated with high biases. Via a nationwide investigation, this study revealed high contributions to energy supply from coal and biomass fuels in the rural household energy sector, while electricity comprised ∼20%. Stacking (the use of multiple sources of energy) is significant, and the average number of energy types was 2.8 per household. Compared to 2012, the consumption of biomass and coals in 2017 decreased by 45% and 12%, respectively, while the gas consumption amount increased by 204%. Increased gas and decreased coal consumptions were mainly in cooking, while decreased biomass was in both cooking (41%) and heating (59%). The time-sharing fraction of electricity and gases (E&G) for daily cooking grew, reaching 69% in 2017, but for space heating, traditional solid fuels were still dominant, with the national average shared fraction of E&G being only 20%. The non-uniform spatial distribution and the non-linear increase in the fraction of E&G indicated challenges to achieving universal access to modern cooking energy by 2030, particularly in less-developed rural and mountainous areas. In some non-typical heating zones, the increased share of E&G for heating was significant and largely driven by income growth, but in typical heating zones, the time-sharing fraction was <5% and was not significantly increased, except in areas with policy intervention. The intervention policy not only led to dramatic increases in the clean energy fraction for heating but also accelerated the clean cooking transition. Higher income, higher education, younger age, less energy/stove stacking and smaller family size positively impacted the clean energy transition.
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Affiliation(s)
- Guofeng Shen
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Rui Xiong
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Yanlin Tian
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
- Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control (AEMPC), Nanjing University of Information Science and Technology, Nanjing 210044, China
| | - Zhihan Luo
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Bahabaike Jiangtulu
- Institute of Reproductive and Child Health, Peking University, Beijing 100191, China
| | - Wenjun Meng
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Wei Du
- Laboratory of Geographic Information Science, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
| | - Jing Meng
- The Bartlett School of Sustainable Construction, University College London, London WC1E 7HB, UK
| | - Yuanchen Chen
- College of Environment, Zhejiang University of Technology, Hangzhou 310014, China
| | - Bing Xue
- Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016, China
| | - Bin Wang
- Institute of Reproductive and Child Health, Peking University, Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yonghong Duan
- College of Resources and Environment, Shanxi Agricultural University, Jinzhong 030801, China
| | - Jia Duo
- Xinjiang Key Laboratory of Environmental Pollution and Bioremediation, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi 830011, China
- National Engineering Technology Research Center for Desert-Oasis Ecological Construction, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi 830011, China
- Universityof Chinese Academy of Sciences, Beijing 100049, China
| | - Fenggui Fan
- School of Geography and Tourism, Anhui University, Wuhu 241000, China
| | - Lei Huang
- School of Environment, Nanjing University, Nanjing 210033, China
| | - Tianzhen Ju
- College of Geography and Environmental Science, Northwest Normal University, Lanzhou 730070, China
| | - Fenggui Liu
- College of Geographical Science, Qinghai Normal University, Xining 810008, China
- Academy of Plateau Science and Sustainability, Xining 810008, China
| | - Shunxin Li
- College of Chemistry, Chemical Engineering and Environment, Minnan Normal University, Zhangzhou 363000, China
| | - Xianli Liu
- School of Environmental Science and Engineering, Hubei Polytechnic University, Huangshi 435003, China
| | - Yungui Li
- Department of Environmental Engineering, Southwest University of Science and Technology, Mianyang 621010, China
| | - Mu Wang
- College of Food Science, Tibet Agricultural and Animal Husbandry University, Linzhi 860000, China
| | - Ying Nan
- College of Geography and Ocean Sciences, Yanbian University, Yanji 133002, China
| | - Bo Pan
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming 650500, China
| | - Yanfang Pan
- College of Geography and Environmental Science, Henan University, Kaifeng 475001, China
| | - Lizhi Wang
- College of Ecology and Environment, Hainan University, Haikou 570228, China
| | - Eddy Zeng
- School of Environment, Jinan University, Guangzhou 510632, China
| | - Chao Zhan
- Institute of Coastal Research, Ludong University, Yantai 264025, China
| | - Yilin Chen
- College of Environmental Science and Technology, Southern University of Science and Technology, Shenzhen 518055, China
| | - Huizhong Shen
- College of Environmental Science and Technology, Southern University of Science and Technology, Shenzhen 518055, China
| | - Hefa Cheng
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Shu Tao
- College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
- College of Environmental Science and Technology, Southern University of Science and Technology, Shenzhen 518055, China
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Islam MM, Wathore R, Zerriffi H, Marshall JD, Bailis R, Grieshop AP. Assessing the Effects of Stove Use Patterns and Kitchen Chimneys on Indoor Air Quality during a Multiyear Cookstove Randomized Control Trial in Rural India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:8326-8337. [PMID: 35561333 DOI: 10.1021/acs.est.1c07571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We conducted indoor air quality (IAQ) measurements during a multiyear cookstove randomized control trial in two rural areas in northern and southern India. A total of 1205 days of kitchen PM2.5 were measured in control and intervention households during six ∼3 month long measurement periods across two study locations. Stoves used included traditional solid fuel (TSF), improved biomass, and liquefied petroleum gas (LPG) models. Intent-to-treat analysis indicates that the intervention reduced average 24 h PM2.5 and black carbon in only one of the two follow-up measurement periods in both areas, suggesting mixed effectiveness. Average PM2.5 levels were ∼50% lower in households with LPG (for exclusive LPG use: >75% lower) than in those without LPG. PM2.5 was 66% lower in households making exclusive use of an improved chimney stove versus a traditional chimney stove and TSF-exclusive kitchens with a built-in chimney had ∼60% lower PM2.5 than those without a chimney, indicating that kitchen ventilation can be as important as the stove technology in improving IAQ. Diurnal trends in real-time PM2.5 indicate that kitchen chimneys were especially effective at reducing peak concentrations, which leads to decreases in daily PM2.5 in these households. Our data demonstrate a clear hierarchy of IAQ improvement in real world, "stove-stacking" households, driven by different stove technologies and kitchen characteristics.
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Affiliation(s)
- Mohammad Maksimul Islam
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina 27695-7908, United States
| | - Roshan Wathore
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina 27695-7908, United States
| | - Hisham Zerriffi
- Department of Forest Resources Management, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Julian D Marshall
- Civil & Environmental Engineering, University of Washington, Seattle, Washington 98195-2700, United States
| | - Rob Bailis
- Stockholm Environmental Institute─US Centre, Somerville, Massachusetts 02144-1224, United States
| | - Andrew P Grieshop
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina 27695-7908, United States
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8
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Liao J, Kirby MA, Pillarisetti A, Piedrahita R, Balakrishnan K, Sambandam S, Mukhopadhyay K, Ye W, Rosa G, Majorin F, Dusabimana E, Ndagijimana F, McCracken JP, Mollinedo E, de Leon O, Díaz-Artiga A, Thompson LM, Kearns KA, Naeher L, Rosenthal J, Clark ML, Steenland K, Waller LA, Checkley W, Peel JL, Clasen T, Johnson M. LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 291:118198. [PMID: 34740288 PMCID: PMC8593210 DOI: 10.1016/j.envpol.2021.118198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 05/26/2023]
Abstract
The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM2.5 for 24 or 48 h using gravimetric-based PM2.5 samplers at baseline and two follow-ups over two months after delivery of an LPG cookstove and free fuel supply. Mixed models were used to estimate PM2.5 reductions. Median kitchen PM2.5 concentrations were 296 μg/m3 at baseline (interquartile range, IQR: 158-507), 24 μg/m3 at first follow-up (IQR: 18-37), and 23 μg/m3 at second follow-up (IQR: 14-37). Median personal exposures to PM2.5 were 134 μg/m3 at baseline (IQR: 71-224), 35 μg/m3 at first follow-up (IQR: 23-51), and 32 μg/m3 at second follow-up (IQR: 23-47). Overall, the LPG intervention was associated with a 92% (95% confidence interval (CI): 90-94%) reduction in kitchen PM2.5 concentrations and a 74% (95% CI: 70-79%) reduction in personal PM2.5 exposures. Results were similar for each site. CONCLUSIONS: The intervention was associated with substantial reductions in kitchen and personal PM2.5 overall and in all sites. Results suggest LPG interventions in these rural settings may lower exposures to the WHO annual interim target-1 of 35 μg/m3. The range of exposure contrasts falls on steep sections of estimated exposure-response curves for birthweight, blood pressure, and acute lower respiratory infections, implying potentially important health benefits when transitioning from solid fuels to LPG.
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Affiliation(s)
- Jiawen Liao
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Miles A Kirby
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kalpana Balakrishnan
- SRU-ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sankar Sambandam
- SRU-ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Krishnendu Mukhopadhyay
- SRU-ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Wenlu Ye
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ghislaine Rosa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona Majorin
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - John P McCracken
- Center for Health Studies, Universidad del Valle De Guatemala, Guatemala City, Guatemala; College of Public Health, University of Georgia, Athens, GA, USA
| | - Erick Mollinedo
- Center for Health Studies, Universidad del Valle De Guatemala, Guatemala City, Guatemala; College of Public Health, University of Georgia, Athens, GA, USA
| | - Oscar de Leon
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Center for Health Studies, Universidad del Valle De Guatemala, Guatemala City, Guatemala
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle De Guatemala, Guatemala City, Guatemala
| | - Lisa M Thompson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Luke Naeher
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Joshua Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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9
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Quinn AK, Williams KN, Thompson LM, Harvey SA, Piedrahita R, Wang J, Quinn C, Pillarisetti A, McCracken JP, Rosenthal JP, Kirby MA, Diaz Artiga A, Thangavel G, Rosa G, Miranda JJ, Checkley W, Peel JL, Clasen TF. Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12592. [PMID: 34886324 PMCID: PMC8656791 DOI: 10.3390/ijerph182312592] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. METHODS The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). RESULTS 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0-15.0) days post-randomization and had a gestational age of 17.9 (15.4-20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). CONCLUSIONS The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.
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Affiliation(s)
- Ashlinn K. Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
- Berkeley Air Monitoring Group, Fort Collins, CO 80524, USA;
| | - Kendra N. Williams
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (K.N.W.); (W.C.)
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
| | - Steven A. Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | | | - Jiantong Wang
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (J.W.); (A.P.); (T.F.C.)
| | - Casey Quinn
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
| | - Ajay Pillarisetti
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (J.W.); (A.P.); (T.F.C.)
| | - John P. McCracken
- Department of Epidemiology and Biostatistics, Global Health Institute, College of Public Health, University of Georgia, Athens, GA 30606, USA;
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Joshua P. Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Anaité Diaz Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute for Higher Education and Research, Porur, Chennai 600116, India;
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - J. Jaime Miranda
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (K.N.W.); (W.C.)
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Jennifer L. Peel
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA;
| | - Thomas F. Clasen
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (J.W.); (A.P.); (T.F.C.)
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10
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Haddad Z, Williams KN, Lewis JJ, Prats EV, Adair-Rohani H. Expanding data is critical to assessing gendered impacts of household energy use. BMJ 2021; 375:n2273. [PMID: 34649862 PMCID: PMC8515214 DOI: 10.1136/bmj.n2273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zeenah Haddad and colleagues call for an expansion of data on household energy use routinely collected through national surveys to gauge the health effects by gender
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Affiliation(s)
- Zeenah Haddad
- Department for Environment, Climate Change, and Health, World Health Organization, Geneva, Switzerland
| | - Kendra N Williams
- Department for Environment, Climate Change, and Health, World Health Organization, Geneva, Switzerland
| | - Jessica J Lewis
- Department for Environment, Climate Change, and Health, World Health Organization, Geneva, Switzerland
| | - Elena Villalobos Prats
- Department for Environment, Climate Change, and Health, World Health Organization, Geneva, Switzerland
| | - Heather Adair-Rohani
- Department for Environment, Climate Change, and Health, World Health Organization, Geneva, Switzerland
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11
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Shupler M, Mwitari J, Gohole A, Anderson de Cuevas R, Puzzolo E, Čukić I, Nix E, Pope D. COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs. RENEWABLE & SUSTAINABLE ENERGY REVIEWS 2021. [PMID: 34276242 DOI: 10.1101/2020.05.27.20115113v1.full.pdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.
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Affiliation(s)
- Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - James Mwitari
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Arthur Gohole
- School of Public Health, Amref International University, Nairobi, Kenya
| | | | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), 654 Madison Avenue, New York, United States
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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12
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Shupler M, Mwitari J, Gohole A, Anderson de Cuevas R, Puzzolo E, Čukić I, Nix E, Pope D. COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs. RENEWABLE & SUSTAINABLE ENERGY REVIEWS 2021; 144:None. [PMID: 34276242 PMCID: PMC8262075 DOI: 10.1016/j.rser.2021.111018] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 05/12/2023]
Abstract
This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.
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Affiliation(s)
- Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - James Mwitari
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Arthur Gohole
- School of Public Health, Amref International University, Nairobi, Kenya
| | | | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), 654 Madison Avenue, New York, United States
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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13
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Shupler M, O'Keefe M, Puzzolo E, Nix E, Anderson de Cuevas R, Mwitari J, Gohole A, Sang E, Čukić I, Menya D, Pope D. Pay-as-you-go liquefied petroleum gas supports sustainable clean cooking in Kenyan informal urban settlement during COVID-19 lockdown. APPLIED ENERGY 2021; 292:116769. [PMID: 34140750 PMCID: PMC8121759 DOI: 10.1016/j.apenergy.2021.116769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Approximately 2.8 billion people rely on polluting fuels (e.g. wood, kerosene) for cooking. With affordability being a key access barrier to clean cooking fuels, such as liquefied petroleum gas (LPG), pay-as-you-go (PAYG) LPG smart meter technology may help resource-poor households adopt LPG by allowing incremental fuel payments. To understand the potential for PAYG LPG to facilitate clean cooking, objective evaluations of customers' cooking and spending patterns are needed. This study uses novel smart meter data collected between January 2018-June 2020, spanning COVID-19 lockdown, from 426 PAYG LPG customers living in an informal settlement in Nairobi, Kenya to evaluate stove usage (e.g. cooking events/day, cooking event length). Seven semi-structured interviews were conducted in August 2020 to provide context for potential changes in cooking behaviours during lockdown. Using stove monitoring data, objective comparisons of cooking patterns are made with households using purchased 6 kg cylinder LPG in peri-urban Eldoret, Kenya. In Nairobi, 95% of study households continued using PAYG LPG during COVID-19 lockdown, with consumption increasing from 0.97 to 1.22 kg/capita/month. Daily cooking event frequency also increased by 60% (1.07 to 1.72 events/day). In contrast, average days/month using LPG declined by 75% during lockdown (17 to four days) among seven households purchasing 6 kg cylinder LPG in Eldoret. Interviewed customers reported benefits of PAYG LPG beyond fuel affordability, including safety, time savings and cylinder delivery. In the first study assessing PAYG LPG cooking patterns, LPG use was sustained despite a COVID-19 lockdown, illustrating how PAYG smart meter technology may help foster clean cooking access.
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Affiliation(s)
- Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Corresponding author at: Department of Public Health, Policy and Systems, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool L69 3GB, United Kingdom.
| | | | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), 654 Madison Avenue, New York, United States
| | - Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | | | - James Mwitari
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Arthur Gohole
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Edna Sang
- School of Public Health, Moi University, Eldoret, Kenya
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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14
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Khanwilkar S, Gould CF, DeFries R, Habib B, Urpelainen J. Firewood, forests, and fringe populations: Exploring the inequitable socioeconomic dimensions of Liquified Petroleum Gas (LPG) adoption in India. ENERGY RESEARCH & SOCIAL SCIENCE 2021; 75:102012. [PMID: 33959474 PMCID: PMC8095680 DOI: 10.1016/j.erss.2021.102012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Liquified petroleum gas (LPG) is an important clean fuel alternative for households that rely on burning biomass for daily cooking needs. In India, Pradhan Mantri Ujjwala Yojana (PMUY) has provided poor households with LPG connections since 2016. We investigate cooking fuel use in households to determine the impact of the policy in the Central Indian Highlands Landscape (CIHL). The CIHL has a large population of marginalized social groups, including Indigenous, Scheduled Tribe, Schedule Caste, and Other Backward Caste people. We utilize survey data from 4,994 households within 500 villages living in forested regions collected in 2018 and a satellite-derived measure of forest availability to investigate the household and ecological determinants of LPG adoption and the timing of this adoption (pre- or post-2016). In addition, we document patterns of firewood collection and evaluate the extent to which households acquiring LPG change these activities. The probability of cooking with LPG was lowest for marginalized social groups. We observe that households recently adopting LPG, likely through PMUY, are poorer, more socially marginalized, less educated, and have more forest available nearby than their early-adopter counterparts. While 90% of LPG-using households continue to use firewood, households that have owned LPG for more years report spending less time collecting firewood, indicating a waning reliance on firewood over time. Policies targeting communities with marginalized social groups living near forests can further accelerate LPG adoption and displace firewood use. Despite overall growth in LPG use, disparities in access to clean cooking fuels remain between socioeconomic groups in India.
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Affiliation(s)
| | - Carlos F. Gould
- Columbia University Mailman School of Public Health, New York, United States
| | | | - Bilal Habib
- Wildlife Institute of India, Dehradun, India
| | - Johannes Urpelainen
- Johns Hopkins School of Advanced International Studies, Maryland, United States
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15
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Cohen A, Pillarisetti A, Luo Q, Zhang Q, Li H, Zhong G, Zhu G, Colford JM, Smith KR, Ray I, Tao Y. Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:127002. [PMID: 33275452 PMCID: PMC7717838 DOI: 10.1289/ehp7124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly. OBJECTIVES We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. METHODS We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) concentrations. RESULTS Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (- 0.66 log 10 TTC most probable number/ 100 mL ), followed by boiling with pots (- 0.58 ), and bottled water use (- 0.39 ); all were statistically significant (p < 0.001 ). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio ( RR ) = 0.25 , p < 0.001 ] and reported diarrhea (RR = 0.80 , p = 0.672 ). TTCs were detected in 51% (n = 136 ) of bottled water samples. For households boiling with biomass, modeled PM 2.5 concentrations averaged 79 μ g / m 3 (standard deviation = 21 ). DISCUSSION Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access. https://doi.org/10.1289/EHP7124.
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Affiliation(s)
- Alasdair Cohen
- Public Health Program, Department of Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, Virginia, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Qing Luo
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Qi Zhang
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Hongxing Li
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Gemei Zhong
- Guangxi CDC, Nanning, Guangxi Autonomous Region, China
| | - Gang Zhu
- Henan CDC, Zhengzhou, Henan Province, China
| | - John M. Colford
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Kirk R. Smith
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, Berkeley, California, USA
- Berkeley Water Center, University of California, Berkeley, Berkeley, California, USA
| | - Yong Tao
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
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16
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Harrell BS, Pillarisetti A, Roy S, Ghorpade M, Patil R, Dhongade A, Smith KR, Levine DI, Juvekar S. Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:15313-15319. [PMID: 33185424 DOI: 10.1021/acs.est.0c01818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In India, approximately 480,000 deaths occur annually from exposure to household air pollution from the use of biomass cooking fuels. Displacing biomass use with clean fuels, such as liquefied petroleum gas (LPG), can help reduce these deaths. Through government initiatives, most Indian households now own an LPG stove and one LPG cylinder. Many households, however, continue to regularly use indoor biomass-fueled mud stoves (chulhas) alongside LPG. Focusing on this population in rural Maharashtra, India, this study (N = 186) tests the effects of conditioning a sales offer for a spare LPG cylinder on a reversible commitment requiring initially disabling indoor chulhas. We find that almost all relevant households (>98%) were willing to accept this commitment. Indoor chulha use decreased by 90% (95% CI = 80% to 101%) when the sales offer included the commitment, compared to a 23% decrease (95% CI = 14% to 32%) without it. For both treatment groups, we find that 80% purchased the spare cylinder at the end of the study.
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Affiliation(s)
| | | | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, 411011 India
| | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, 411011 India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, 411011 India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, 411011 India
| | - Kirk R Smith
- University of California, Berkeley, California 94720, United States
| | - David I Levine
- University of California, Berkeley, California 94720, United States
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, 411011 India
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17
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Lu C, Xu H, Meng W, Hou W, Zhang W, Shen G, Cheng H, Wang X, Wang X, Tao S. A novel model for regional indoor PM 2.5 quantification with both external and internal contributions included. ENVIRONMENT INTERNATIONAL 2020; 145:106124. [PMID: 32950792 DOI: 10.1016/j.envint.2020.106124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
PM2.5 (particulate matter with an aerodynamic size ≤ 2.5 μm) of indoor origins is a dominant contributor to the overall air pollution exposure. Although some sophisticated models have been developed to simulate indoor air quality for individual households, it is still challenging to quantify indoor PM2.5 on a regional scale, which is critical for health impact assessments. In this study, a new model was developed to predict indoor PM2.5 concentrations by quantifying the external penetration, as well as the internal contributions. The model was parameterized based on a set of simultaneously measured indoor and outdoor PM2.5 concentrations at five-second temporal resolution for 53 households in Beijing. This study found that indoor PM2.5 concentrations were significantly correlated with those in the outdoor environment with an approximately 1-h lag-time on average. Outdoor-to-indoor penetration dominated the contribution to indoor PM2.5 during polluted hours with relatively high ambient PM2.5 concentrations, while the indoor PM2.5, during clean hours, was contributed by internal sources, including smoking, cooking, incense burning, and human disturbance. The influence of windows, house area, and air purifier use was addressed in the new model. The model was applied to evaluate indoor PM2.5 concentrations in six urban districts of Beijing via an uncertainty analysis. The model was developed based on and applied to households using clean residential energy, and it would be interesting also important to evaluate it in households using solid fuels.
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Affiliation(s)
- Cengxi Lu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Haoran Xu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Wenjun Meng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Weiying Hou
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Wenxiao Zhang
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Guofeng Shen
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Hefa Cheng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Xuejun Wang
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Xilong Wang
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Shu Tao
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China.
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18
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Grajeda LM, Thompson LM, Arriaga W, Canuz E, Omer SB, Sage M, Azziz-Baumgartner E, Bryan JP, McCracken JP. Effectiveness of Gas and Chimney Biomass Stoves for Reducing Household Air Pollution Pregnancy Exposure in Guatemala: Sociodemographic Effect Modifiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217723. [PMID: 33105825 PMCID: PMC7660060 DOI: 10.3390/ijerph17217723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Abstract
Household air pollution (HAP) due to solid fuel use during pregnancy is associated with adverse birth outcomes. The real-life effectiveness of clean cooking interventions has been disappointing overall yet variable, but the sociodemographic determinants are not well described. We measured personal 24-h PM2.5 (particulate matter <2.5 µm in aerodynamic diameter) thrice in pregnant women (n = 218) gravimetrically with Teflon filter, impactor, and personal pump setups. To estimate the effectiveness of owning chimney and liquefied petroleum gas (LPG) stoves (i.e., proportion of PM2.5 exposure that would be prevented) and to predict subject-specific typical exposures, we used linear mixed-effects models with log (PM2.5) as dependent variable and random intercept for subject. Median (IQR) personal PM2.5 in µg/m3 was 148 (90-249) for open fire, 78 (51-125) for chimney stove, and 55 (34-79) for LPG stoves. Adjusted effectiveness of LPG stoves was greater in women with ≥6 years of education (49% (95% CI: 34, 60)) versus <6 years (26% (95% CI: 5, 42)). In contrast, chimney stove adjusted effectiveness was greater in women with <6 years of education (50% (95% CI: 38, 60)), rural residence (46% (95% CI: 34, 55)) and lowest SES (socio-economic status) quartile (59% (95% CI: 45, 70)) than ≥6 years education (16% (95% CI: 22, 43)), urban (23% (95% CI: -164, 42)) and highest SES quartile (-44% (95% CI: -183, 27)), respectively. A minority of LPG stove owners (12%) and no chimney owner had typical exposure below World Health Organization Air Quality guidelines (35 μg/m3). Although having a cleaner stove alone typically does not lower exposure enough to protect health, understanding sociodemographic determinants of effectiveness may lead to better targeting, implementation, and adoption of interventions.
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Affiliation(s)
- Laura M. Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
- Correspondence:
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
| | - William Arriaga
- Regional Hospital, Ministry of Public Health Social Assistance of Guatemala, Quetzaltenango 09001, Guatemala;
| | - Eduardo Canuz
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
| | - Saad B. Omer
- Yale Institute for Global Health, Schools of Public Health & Medicine, Yale University, New Haven, CT 06510, USA;
| | - Michael Sage
- Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | | | - Joe P. Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
- Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City 01015, Guatemala
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
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19
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Champion WM, Warren SH, Kooter IM, Preston W, Krantz QT, DeMarini DM, Jetter JJ. Mutagenicity- and pollutant-emission factors of pellet-fueled gasifier cookstoves: Comparison with other combustion sources. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 739:139488. [PMID: 32526531 PMCID: PMC7676151 DOI: 10.1016/j.scitotenv.2020.139488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 05/13/2023]
Abstract
Emissions from solid-fuel burning cookstoves are associated with 3 to 4 million premature deaths annually and contribute significantly to impacts on climate. Pellet-fueled gasifier stoves have some emission factors (EFs) approaching those of gas-fuel (liquid petroleum gas) stoves; however, their emissions have not been evaluated for biological effects. Here we used a new International Organization for Standardization (ISO) testing protocol to determine pollutant- and mutagenicity-EFs for a stove designed for pellet fuel, the Mimi Moto, and for two other forced-draft stoves, Xunda and Philips HD4012, burning pellets of hardwood or peanut hulls. The Salmonella assay-based mutagenicity-EFs (revertants/megajouledelivered) spanned three orders of magnitude and correlated highly (r = 0.99; n = 5) with EFs of the sum of 32 particle-phase polycyclic aromatic hydrocarbons (PAHs). The Mimi Moto/hardwood pellet combination had total-PAH- and mutagenicity-EFs 99.2 and 96.6% lower, respectively, compared to data published previously for the Philips stove burning non-pelletized hardwood, and 100 and 99.8% lower, respectively, compared to those of a wood-fueled three-stone fire. The Xunda burning peanut hull pellets had the highest fuel energy-based mutagenicity-EF (revertants/megajoulethermal) of the pellet stove/fuel combinations tested, which was between that of diesel exhaust, a known human carcinogen, and a natural-draft wood stove. Although the Mimi Moto burning hardwood pellets had the lowest fuel energy-based mutagenicity-EF, this value was between that of utility coal and utility wood boilers. This advanced stove/fuel combination has the potential to greatly reduce emissions in contrast to a traditional stove, but adequate ventilation is required to approach acceptable levels of indoor air quality.
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Affiliation(s)
- Wyatt M Champion
- Oak Ridge Institute for Science and Education (ORISE), U.S. Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, United States.
| | - Sarah H Warren
- Biomolecular and Computational Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Ingeborg M Kooter
- Department of Environmental Modelling, Sensing and Analyses, Netherlands Organisation for Applied Scientific Research (TNO), Utrecht, the Netherlands
| | | | - Q Todd Krantz
- Biomolecular and Computational Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - David M DeMarini
- Biomolecular and Computational Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - James J Jetter
- Air Methods and Characterization Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
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20
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Williams KN, Kephart JL, Fandiño-Del-Rio M, O'Brien CJ, Moulton LH, Koehler K, Harvey SA, Checkley W. Use of liquefied petroleum gas in Puno, Peru: Fuel needs under conditions of free fuel and near-exclusive use. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2020; 58:150-157. [PMID: 33442225 PMCID: PMC7799435 DOI: 10.1016/j.esd.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Reducing the burden of household air pollution could be achieved with exclusive adoption of cleaner fuels such as liquefied petroleum gas (LPG). However, we lack understanding of how much LPG is required to support exclusive use and how household characteristics affect this quantity. This paper used data from 90 participants in the Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial in Puno, Peru who received free LPG deliveries for one year. Households with a mean of four members that cooked nearly exclusively (>98%) with LPG used an average of 19.1 kg (95% CI 18.5 to 19.6) of LPG per month for tasks similar to those done with the traditional biomass stove. LPG use per month was 0.5 kg higher for each additional pig or dog owned (p=0.003), 0.7 kg higher for each additional household member (p<0.001), 0.3 kg higher for households in the second-lowest compared to the lowest wealth quintile (p=0.01), and 1.1 kg higher if the household had previously received subsidized LPG (p=0.05). LPG use per month was 1.1 kg lower during the rainy season (p<0.001) and 1.7 kg lower during the planting season (p<0.001) compared to the cold and harvest seasons, despite the fact that LPG was not typically used for space heating. LPG use decreased by 0.05 kg per month over the course of one year after receiving the LPG stove (p=0.02). These results suggest that achieving exclusive LPG use in Puno, Peru requires that rural residents have affordable access to an average of two 10 kg LPG tanks per month. Conducting similar investigations in other countries could help policymakers set and target LPG subsidies to ensure that households have access to enough LPG to achieve exclusive LPG use and the potential health benefits.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn J O'Brien
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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21
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Williams KN, Thompson LM, Sakas Z, Hengstermann M, Quinn A, Díaz-Artiga A, Thangavel G, Puzzolo E, Rosa G, Balakrishnan K, Peel J, Checkley W, Clasen TF, Miranda JJ, Rosenthal JP, Harvey SA. Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial. BMJ Open 2020; 10:e037761. [PMID: 32994243 PMCID: PMC7526279 DOI: 10.1136/bmjopen-2020-037761] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda. METHODS Using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial. RESULTS We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits. CONCLUSION Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies. TRIAL REGISTRATION NUMBER NCT02944682, Pre-results.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Zoe Sakas
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mayari Hengstermann
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anaité Díaz-Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Jennifer Peel
- Department of Environmental & Radiological Health Sciences, Colorado School of Public Health, Aurora, Colorado, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas F Clasen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joshua P Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven A Harvey
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Carrión D, Prah R, Gould CF, Agbokey F, Mujtaba M, Pillarisetti A, Tumasi M, Agyei O, Chillrud S, Tawiah T, Jack D, Asante KP. Using longitudinal survey and sensor data to understand the social and ecological determinants of clean fuels use and discontinuance in rural Ghana. ENVIRONMENTAL RESEARCH COMMUNICATIONS 2020; 2:095003. [PMID: 34504994 PMCID: PMC8425314 DOI: 10.1088/2515-7620/abb831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Efforts to reduce the health and ecological burdens of household biomass combustion are underway in Ghana, principally by promoting clean cookstoves and fuels. Recent studies have focused on the sustained use of clean cookstoves, but sometimes household adopt a new cookstove and then end use of that stove. In this study, we introduce a novel framework for understanding and encouraging household transitions to cleaner cooking: clean fuel discontinuance. We leveraged data from the Ghana Randomized Air Pollution and Health Study (GRAPHS) (N = 1412) where pregnant women received either improved biomass (BioLite) or dual burner LPG stoves for free. LPG users were given free LPG refills during GRAPHS. Weekly questionnaires were administered. Stove use monitors tracked a sub-cohort (n = 220) 6 months before and after the fuel subsidy. We examined social and ecological determinants of stove use and discontinuance. Overall intervention stove use adherence was high throughout GRAPHS, with self-reported use at 69% and 86% of participant-weeks for BioLite and LPG arms respectively. Participants used intervention stoves less for meals requiring vigorous stirring. Burns from intervention stoves decreased use among BioLite (RR: 0.96, p = 0.009), but not LPG users. Device breakage was mentioned as an impediment in 18% of free-text responses for LPG users and 1% for BioLite. Tree canopy within a spatial buffer-a plausible proxy for biomass fuels access-was the only variable explaining LPG discontinued stove use in adjusted Cox time-to-event analyses (HR = -0.56, p < 0.001). Future studies should consider the stove use discontinuance framework.
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Affiliation(s)
- D Carrión
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Prah
- Kintampo Health Research Centre, Kintampo, Ghana
| | - C F Gould
- Department of Environmental Health Sciences, Columbia University, New York, United States of America
| | - F Agbokey
- Kintampo Health Research Centre, Kintampo, Ghana
| | - M Mujtaba
- Kintampo Health Research Centre, Kintampo, Ghana
| | - A Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - M Tumasi
- Kintampo Health Research Centre, Kintampo, Ghana
| | - O Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - S Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, United States of America
| | - T Tawiah
- Kintampo Health Research Centre, Kintampo, Ghana
| | - D Jack
- Department of Environmental Health Sciences, Columbia University, New York, United States of America
| | - K P Asante
- Kintampo Health Research Centre, Kintampo, Ghana
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Williams KN, Kephart JL, Fandiño-Del-Rio M, Condori L, Koehler K, Moulton LH, Checkley W, Harvey SA. Beyond cost: Exploring fuel choices and the socio-cultural dynamics of liquefied petroleum gas stove adoption in Peru. ENERGY RESEARCH & SOCIAL SCIENCE 2020; 66:101591. [PMID: 32742936 PMCID: PMC7394288 DOI: 10.1016/j.erss.2020.101591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Reducing the burden of household air pollution requires that cleaner fuels such as liquefied petroleum gas (LPG) be used nearly exclusively. However, exclusive adoption has been challenging in low- and middle-income countries. Previous studies have found that economic, social, and cultural barriers often impede adoption. We conducted in-depth qualitative interviews with 22 participants in a research trial where LPG was provided for free in Puno, Peru. We aimed to determine whether social and cultural barriers to LPG use persisted when monetary costs to the household were removed, and what factors influenced exclusive adoption of LPG in a cost-free context. Facilitators of LPG use included: support from study staff, family support, time savings, previous experience with LPG, stove design, ability to use existing pots, smoke reductions, desire for cleanliness, removal of traditional stoves, and perceptions of luck. Barriers to LPG use included: fears of LPG, problems with LPG brands, delays in obtaining LPG refills, social pressure, perceived incompatibility of traditional dishes, perceived inability to use clay pots, separate kitchens for LPG and traditional stoves, designated pots for use on the traditional stove, and lack of heat. However, these barriers did not prevent participants from using LPG nearly exclusively. Results suggest that social and cultural barriers to exclusive LPG use can be overcome when LPG stoves and fuel are provided for free and supplemented with behavioral support. Governments should evaluate the economic feasibility and sustainability of LPG subsidization, considering the potential benefits of exclusive LPG use.
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Affiliation(s)
- Kendra N Williams
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leonora Condori
- Biomedical Research Unit, Asociación Benéfica PRISMA, Puno, Peru
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Mani S, Jain A, Tripathi S, Gould CF. The drivers of sustained use of liquified petroleum gas in India. NATURE ENERGY 2020; 5:450-457. [PMID: 32719732 PMCID: PMC7384753 DOI: 10.1038/s41560-020-0596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Ninety-five per cent of Indian households now have access to liquified petroleum gas (LPG), with 80 million acquiring it under the Pradhan Mantri Ujjwala Yojana (PMUY) since 2016. Still, having a connection is not enough to eliminate household air pollution. Studying panel data from rural households in six major states from 2014-2015 and 2018, we assess the determinants of cooking energy transition from solid fuels to LPG. We find that PMUY beneficiaries have much lower odds of using LPG as the primary or exclusive fuel compared with general customers, irrespective of their economic status. Village-level penetration of LPG as a primary fuel and the years of LPG use positively influence its sustained use, while ease of access to freely available biomass and reliance on uncertain and irregular income sources hinder LPG use. The findings highlight the need to interlace cooking fuel policies with rural development, to enable a complete transition towards cleaner cooking fuels.
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Affiliation(s)
- Sunil Mani
- Council on Energy, Environment and Water, New Delhi, India
| | - Abhishek Jain
- Council on Energy, Environment and Water, New Delhi, India
| | | | - Carlos F Gould
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA
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25
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Shankar AV, Quinn A, Dickinson KL, Williams KN, Masera O, Charron D, Jack D, Hyman J, Pillarisetti A, Bailis R, Kumar P, Ruiz-Mercado I, Rosenthal J. Everybody Stacks: Lessons from household energy case studies to inform design principles for clean energy transitions. ENERGY POLICY 2020; 141:111468. [PMID: 32476710 PMCID: PMC7259482 DOI: 10.1016/j.enpol.2020.111468] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Stove stacking (concurrent use of multiple stoves and/or fuels) is a poorly quantified practice in regions where efforts to transition household energy to cleaner stoves/or fuels are on-going. Using biomass-burning stoves alongside clean stoves undermines health and environmental goals. This review synthesizes stove stacking data gathered from eleven case studies of clean cooking programs in low/middle-income country settings. Analyzed data are from ministry and program records, research studies, and informant interviews. Thematic analysis identify key drivers of stove stacking behavior in each setting. Significant (28%-100%) stacking with traditional cooking methods was observed in all cases. Reason for traditional fuel use includes: costs of clean fuel; mismatches between cooking technologies and household needs; and unreliable fuel supply. National household surveys often focus on 'primary' cookstoves and miss stove stacking data. Thus more attention should be paid to discontinuation of traditional stove use, not solely adoption of cleaner stoves/fuels. Future energy policies and programs should acknowledge the realities of stacking and incorporate strategies at the design stage to transition away from polluting stoves/fuels. Seven principles for clean cooking system program design and policy are presented, focused on a shift toward "cleaner stacking" that could yield household air pollution reductions approaching WHO targets.
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Affiliation(s)
- Anita V Shankar
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Omar Masera
- Instituto de Investigaciones en Ecosistemas y Sustentabilidad, Universidad Nacional Autónoma de México, Morelia, Michoacán. Mexico
| | - Dana Charron
- Berkeley Air Monitoring Group, Berkeley, CA, USA
| | | | | | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rob Bailis
- Stockholm Environment Institute, Somerville, MA, USA
| | | | - Ilse Ruiz-Mercado
- Escuela Nacional de Estudios Superiores Unidad Mérida, Universidad Nacional Autónoma de México (UNAM), Mérida, Yucatán, Mexico
| | - Joshua Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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26
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Piedrahita R, Johnson M, Bilsback KR, L'Orange C, Kodros JK, Eilenberg SR, Naluwagga A, Shan M, Sambandam S, Clark M, Pierce JR, Balakrishnan K, Robinson AL, Volckens J. Comparing regional stove-usage patterns and using those patterns to model indoor air quality impacts. INDOOR AIR 2020; 30:521-533. [PMID: 31943353 PMCID: PMC8886689 DOI: 10.1111/ina.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 05/05/2023]
Abstract
Monitoring improved cookstove adoption and usage in developing countries can help anticipate potential health and environmental benefits that may result from household energy interventions. This study explores stove-usage monitor (SUM)-derived usage data from field studies in China (52 stoves, 1422 monitoring days), Honduras (270 stoves, 630 monitoring days), India (19 stoves, 565 monitoring days), and Uganda (38 stoves, 1007 monitoring days). Traditional stove usage was found to be generally similar among four seemingly disparate countries in terms of cooking habits, with average usage of between 171 and 257 minutes per day for the most-used stoves. In Honduras, where survey-based usage data were also collected, there was only modest agreement between sensor data and self-reported user data. For Indian homes, we combined stove-usage data with a single-zone Monte Carlo box model to estimate kitchen-level PM2.5 and CO concentrations under various scenarios of cleaner cookstove adoption. We defined clean cookstove performance based on the International Standards Organization (ISO) voluntary guidelines. Model results showed that even with 75% displacement of traditional stoves with the cleanest available stove (ISO tier-5), World Health Organization 24 hours PM2.5 standards were exceeded in 96.4% of model runs, underscoring the importance of full displacement.
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Affiliation(s)
| | | | - Kelsey R Bilsback
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO
| | - John K Kodros
- Department of Atmospheric Science, Colorado State University, Fort Collins, CO
| | - Sarah Rose Eilenberg
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Agnes Naluwagga
- Centre for Research in Energy and Energy Conservation (CREEC), Kampala, Uganda
| | - Ming Shan
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
| | - Sankar Sambandam
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Maggie Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO
| | - Jeffrey R Pierce
- Department of Atmospheric Science, Colorado State University, Fort Collins, CO
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Allen L Robinson
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO
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Mazorra J, Sánchez-Jacob E, de la Sota C, Fernández L, Lumbreras J. A comprehensive analysis of cooking solutions co-benefits at household level: Healthy lives and well-being, gender and climate change. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 707:135968. [PMID: 31869607 DOI: 10.1016/j.scitotenv.2019.135968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 05/05/2023]
Abstract
Three billion people (>40% of the world's population) lack access to clean cooking solutions, including 2.5 billion people that still rely on the traditional use of biomass for cooking. In urban contexts, the rate of access to clean cooking solutions is normally higher than in rural contexts due to greater availability of these solutions. The relevance of providing access to clean cooking solutions (SDG 7) is linked to several associated co-benefits that contribute to a wide range of Sustainable Development Goals (SDGs). Therefore, this paper shows a comprehensive analysis of multiple co-benefits of a clean cooking solution intervention. Health (SDG 3), gender (SDG 5) and climate change (SDG 13) co-benefits were analysed and compared through a cost-benefit analysis using a comprehensive approach in a case study in the Casamance Natural Subregion, located in Western Africa. The most important co-benefits were related to gender (SDG 5), representing 60-97% of the total economic benefits. Climate change co-benefits (SDG 13) were also relevant, representing 3-40% of the total economic benefits. Health co-benefits (SDG 3) were very limited for this case study, representing <1% of the total economic benefits. Considering these results, implications for urban settings were discussed in the light of the "making the available clean" or "making the clean available" strategies.
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Affiliation(s)
- Javier Mazorra
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain.
| | - Eduardo Sánchez-Jacob
- Department of Chemical and Environmental Engineering, Higher Technical School of Industrial Engineering, Technical University of Madrid (UPM), c/ José Gutiérrez Abascal, 2, 28006 Madrid, Spain
| | - Candela de la Sota
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain
| | - Luz Fernández
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain
| | - Julio Lumbreras
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain; Department of Chemical and Environmental Engineering, Higher Technical School of Industrial Engineering, Technical University of Madrid (UPM), c/ José Gutiérrez Abascal, 2, 28006 Madrid, Spain; Harvard Kennedy School of Government, 79 JFK St, Cambridge 02138, MA, USA
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28
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An Integrated Sensor Data Logging, Survey, and Analytics Platform for Field Research and Its Application in HAPIN, a Multi-Center Household Energy Intervention Trial. SUSTAINABILITY 2020. [DOI: 10.3390/su12051805] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Researchers rely on sensor-derived data to gain insights on numerous human behaviors and environmental characteristics. While commercially available data-logging sensors can be deployed for a range of measurements, there have been limited resources for integrated hardware, software, and analysis platforms targeting field researcher use cases. In this paper, we describe Geocene, an integrated sensor data logging, survey, and analytics platform for field research. We provide an example of Geocene’s ongoing use in the Household Air Pollution Intervention Network (HAPIN). HAPIN is a large, multi-center, randomized controlled trial evaluating the impacts of a clean cooking fuel and stove intervention in Guatemala, India, Peru, and Rwanda. The platform includes Bluetooth-enabled, data-logging temperature sensors; a mobile application to survey participants, provision sensors, download sensor data, and tag sensor missions with metadata; and a cloud-based application for data warehousing, visualization, and analysis. Our experience deploying the Geocene platform within HAPIN suggests that the platform may have broad applicability to facilitate sensor-based monitoring and evaluation efforts and projects. This data platform can unmask heterogeneity in study participant behavior by using sensors that capture both compliance with and utilization of the intervention. Platforms like this could help researchers measure adoption of technology, collect more robust intervention and covariate data, and improve study design and impact assessments.
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29
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Gould CF, Schlesinger SB, Molina E, Bejarano ML, Valarezo A, Jack DW. Household fuel mixes in peri-urban and rural Ecuador: Explaining the context of LPG, patterns of continued firewood use, and the challenges of induction cooking. ENERGY POLICY 2020; 136:111053. [PMID: 32675905 PMCID: PMC7365656 DOI: 10.1016/j.enpol.2019.111053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Nationwide transitions from cooking with solid fuels to clean fuels promise substantial health, climate, and environmental benefits. For decades, Ecuador has invested heavily in consumption subsidies for liquified petroleum gas (LPG), a leading clean fuel. With the goal of understanding household energy use in a context where LPG is ubiquitous and cheap, we administered 808 household surveys in peri-urban and rural communities in Coastal and Andean Ecuadorian provinces. We assess cooking fuel patterns after long-term LPG access and the reach of induction stoves promoted through a recent government program. Nearly all participants reported using LPG for more than a decade and frequent, convenient access to highly subsidized LPG. Nonetheless, half of rural households and 20% of peri-urban households rely on firewood to meet specific household energy needs, like space heating or heating water for bathing. Induction was rare and many induction owners reported zero use because the required equipment had never been installed by electricity companies, their stove had broken, or due to fears of high electricity costs. Our discussion is instructive for other countries because of Ecuador's long-standing clean fuel policies, robust LPG market and standardized cylinder recirculation model, and promotion of induction stoves.
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Affiliation(s)
- Carlos F. Gould
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Emilio Molina
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Miryan L. Bejarano
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Alfredo Valarezo
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Darby W. Jack
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA
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30
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Quinn AK, Neta G, Sturke R, Olopade CO, Pollard SL, Sherr K, Rosenthal JP. Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries. Front Public Health 2019; 7:389. [PMID: 31921753 PMCID: PMC6932973 DOI: 10.3389/fpubh.2019.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/02/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: The use of models and frameworks to design and evaluate strategies to improve delivery of evidence-based interventions is a foundational element of implementation science. To date, however, evaluative implementation science frameworks such as Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) have not been widely employed to examine environmental health interventions. We take advantage of a unique opportunity to utilize and iteratively adapt the RE-AIM framework to guide NIH-funded case studies of the implementation of clean cooking fuel programs in eleven low- and middle-income countries. Methods: We used existing literature and expert consultation to translate and iteratively adapt the RE-AIM framework across several stages of the NIH Clean Cooking Implementation Science case study project. Checklists and templates to guide investigators were developed at each stage. Results: The RE-AIM framework facilitated identification of important emerging issues across this set of case studies, in particular highlighting the fact that data associated with certain important outcomes related to health and welfare are chronically lacking in clean fuel programs. Monitoring of these outcomes should be prioritized in future implementation efforts. As RE-AIM was not originally designed to evaluate household energy interventions, employing the framework required adaptation. Specific adaptations include the broadening of Effectiveness to encompass indicators of success toward any stated programmatic goal, and expansion of Adoption to include household-level uptake of technology. Conclusions: The RE-AIM implementation science framework proved to be a useful organizing schema for 11 case studies of clean fuel cooking programs, in particular highlighting areas requiring emphasis in future research and evaluation efforts. The iterative approach used here to adapt an implementation science framework to a specific programmatic goal may be of value to other multi-country program efforts, such as those led by international development agencies. The checklists and templates developed for this project are publicly available for others to use and/or further modify.
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Affiliation(s)
- Ashlinn K. Quinn
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, MD, United States
| | - Gila Neta
- National Cancer Institute, U.S. National Institutes of Health, Bethesda, MD, United States
| | - Rachel Sturke
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, MD, United States
| | | | - Suzanne L. Pollard
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Joshua P. Rosenthal
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, MD, United States
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31
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Carter E, Yan L, Fu Y, Robinson B, Kelly F, Elliott P, Wu Y, Zhao L, Ezzati M, Yang X, Chan Q, Baumgartner J. Household Transitions to Clean Energy in a Multi-Provincial Cohort Study in China. NATURE SUSTAINABILITY 2019; 3:42-50. [PMID: 37767329 PMCID: PMC7615133 DOI: 10.1038/s41893-019-0432-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/18/2019] [Indexed: 09/29/2023]
Abstract
Household solid fuel (biomass, coal) burning contributes to climate change and is a leading health risk factor. How and why households stop using solid fuel stoves after adopting clean fuels has not been studied. We assessed trends in the uptake, use, and suspension of household stoves and fuels in a multi-provincial cohort study of 753 Chinese adults and evaluated determinants of clean fuel uptake and solid fuel suspension. Over one-third (35%) and one-fifth (17%) of participants suspended use of solid fuel for cooking and heating, respectively, during the past 20 years. Determinants of solid fuel suspension (younger age, widowed) and of earlier suspension (younger age, higher education, and poor self-reported health status) differed from the determinants of clean fuel uptake (younger age, higher income, smaller households, and retired) and of earlier adoption (higher income). Clean fuel adoption and solid fuel suspension warrant joint consideration as indicators of household energy transition. Household energy research and planning efforts that more closely examine solid fuel suspension may accelerate household energy transitions that benefit climate and human health.
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Affiliation(s)
- Ellison Carter
- Department of Civil and Environmental Engineering, Colorado State University, 1372 Campus Delivery, Fort Collins, CO, USA 80524
- Institute on the Environment, University of Minnesota, 1954 Buford Avenue, Saint Paul, MN, USA, 55108
| | - Li Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, Kings College London, 150 Stamford Street, London, UK SE1 1UL
| | - Yu Fu
- Department of Building Science, School of Architecture, Tsinghua University, 1 QingHua Yuan Road, Beijing, China 100084
| | - Brian Robinson
- Department of Geography, McGill University, 805 Sherbrooke Street West, Montreal, Canada H3A 0B9
| | - Frank Kelly
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, Kings College London, 150 Stamford Street, London, UK SE1 1UL
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
| | - Yangfeng Wu
- Peking University Clinical Research Institute, 38 Xueyuan Road, Beijing, China 100191
| | - Liancheng Zhao
- National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China 100006
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
| | - Xudong Yang
- Department of Building Science, School of Architecture, Tsinghua University, 1 QingHua Yuan Road, Beijing, China 100084
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place St. Mary's Campus, London, UK W2 1PG
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1110 Pine Avenue West, Montreal, Canada H3A 1A3
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Schilmann A, Riojas-Rodríguez H, Catalán-Vázquez M, Estevez-García JA, Masera O, Berrueta-Soriano V, Armendariz-Arnez C, Pérez-Padilla R, Cortez-Lugo M, Rodríguez-Dozal S, Romieu I. A follow-up study after an improved cookstove intervention in rural Mexico: Estimation of household energy use and chronic PM 2.5 exposure. ENVIRONMENT INTERNATIONAL 2019; 131:105013. [PMID: 31352264 DOI: 10.1016/j.envint.2019.105013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 05/24/2023]
Abstract
The benefits of improved biomass cookstoves (ICS) depends on their adoption and sustained use. Few studies have documented if and how they are used more than five years after being introduced. We conducted a 9-year prospective cohort study among young rural women in the highlands of Michoacan, Mexico. Participants had received a Patsari ICS during a community trial either in 2005 or 2006. With retrospective information collected in 2012-13, we studied the households' energy use, ICS survival, and cooking practices during the follow-up period. Using an exposure model constructed with personal PM2.5 measurements in a subsample of homes at the time of the initial trial in 2005, we estimated the exposure associated with different energy use patterns during the follow-up period. The ICS had a mean lifespan of 4 years, after which more than half of the stoves were not in use; therefore, the use of open fire increased, particularly among the indigenous communities. ICS use peak was achieved two years after the initial trial, either exclusively or combined with open fire. Yearly household energy use and other variables were used to estimate chronic air pollution exposure. Mean PM2.5 exposure during the follow-up period ranged from 51 to 319 μg/m3; the median was 102 and 146 μg/m3 for mainly ICS and mainly open fire use, respectively. The ICS has a useful period after which it needs maintenance, repair, or replacement. Unfortunately, many programs have not afforded a follow-up component. Exposure to biomass smoke air pollutants can be reduced by using an ICS instead of the traditional open fire. Household energy strategies should ensure equitable access to clean energy options adapted to local needs and preferences with culturally appropriate technology implemented on a sustainable perspective.
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Affiliation(s)
- Astrid Schilmann
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Horacio Riojas-Rodríguez
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
| | - Minerva Catalán-Vázquez
- Clinical Epidemiology Department, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Jesús Alejandro Estevez-García
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Omar Masera
- Institute for Ecosystem and Sustainability Research, National Autonomous University of Mexico (UNAM), Morelia, Michoacan, Mexico
| | - Víctor Berrueta-Soriano
- Interdisciplinary Group on Appropriate Rural Technology (GIRA), Patzcuaro, Michoacan, Mexico
| | - Cynthia Armendariz-Arnez
- Escuela Nacional de Estudios Superiores Unidad Morelia, National Autonomous University of Mexico (UNAM), Morelia, Michoacan, Mexico
| | - Rogelio Pérez-Padilla
- Tobacco and COPD Department, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Marlene Cortez-Lugo
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Sandra Rodríguez-Dozal
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Isabelle Romieu
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Hubert Department of Global Health, Emory University, Atlanta, GA, USA
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Clark SN, Schmidt AM, Carter EM, Schauer JJ, Yang X, Ezzati M, Daskalopoulou SS, Baumgartner J. Longitudinal evaluation of a household energy package on blood pressure, central hemodynamics, and arterial stiffness in China. ENVIRONMENTAL RESEARCH 2019; 177:108592. [PMID: 31351323 DOI: 10.1016/j.envres.2019.108592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/15/2019] [Accepted: 07/15/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cardiovascular diseases are the leading contributors to disease burden in China and globally, and household air pollution exposure is associated with risk of cardiovascular disease. OBJECTIVES We evaluated whether subclinical cardiovascular outcomes in adult Chinese women would improve after distribution of an energy package comprised of a semi-gasifier cookstove, water heater, chimney, and supply of processed biomass fuel. METHODS We enrolled 204 households (n = 205 women) from 12 villages into a controlled before- and after-intervention study on cardiovascular health and air pollution in Sichuan Province. The intervention was distributed to 124 households during a government-sponsored rural energy demonstration program. The remaining 80 households received the package 18 months later at the end of the study, forming a comparison group. One woman from each household had their blood pressure (BP), central hemodynamics, and arterial stiffness measured along with exposures to air pollution and demographic and household characteristics, on up to five visits. We used a difference-in-differences mixed-effects regression approach with Bayesian inference to assess the impact of the energy package on sub-clinical cardiovascular outcomes. RESULTS Women who did not receive the energy package had greater mean decreases in brachial systolic (-4.1 mmHg, 95% credible interval (95%CIe) -7.3, -0.9) and diastolic BP (-2.0 mmHg, 95%CIe -3.6, -0.5) compared with women who received the package (systolic: -2.7, 95%CIe -5.0, -0.4; diastolic: -0.3, 95%CIe -1.4, 0.8) resulting in slightly positive but not statistically significant difference-in-differences effect estimates of 1.3 mmHg (95%CIe -2.5, 5.2) and 1.7 mmHg (95%CIe -0.3, 3.6), respectively. Similar trends were found for central BP, central pulse pressure, and arterial stiffness. Air pollution exposures decreased on average for both treatment groups, with a greater range of reductions among women who did not receive the package (with package: -30% to -50%; without package: +2% to -69%), likely as a result of increased use of gas fuel and electric stoves among this group. Outdoor air quality changed very little over time. CONCLUSIONS Gasifier stoves have been widely promoted as the next generation of 'clean-cooking' technologies, however their effectiveness in improving health in real-world settings should be carefully evaluated and communicated before scaling up their implementation.
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Affiliation(s)
- Sierra N Clark
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Ellison M Carter
- Institute on the Environment, University of Minnesota, Minneapolis, USA; Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, USA
| | - James J Schauer
- Department of Civil and Environmental Engineering, University of Wisconsin, Madison, USA; Environmental Chemistry & Technology Program, University of Wisconsin, Madison, USA
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Majid Ezzati
- School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment and Health, Imperial College London, UK
| | - Stella S Daskalopoulou
- Department of Medicine, Division of Internal Medicine, McGill University, Montreal, Canada
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada; Institute on the Environment, University of Minnesota, Minneapolis, USA.
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Shupler M, Hystad P, Gustafson P, Rangarajan S, Mushtaha M, Jayachtria KG, Mony PK, Mohan D, Kumar P, Lakshmi PVM, Sagar V, Gupta R, Mohan I, Nair S, Varma RP, Li W, Hu B, You K, Ncube T, Ncube B, Chifamba J, West N, Yeates K, Iqbal R, Khawaja R, Yusuf R, Khan A, Seron P, Lanas F, Lopez-Jaramillo P, Camacho PA, Puoane T, Yusuf S, Brauer M. Household, Community, Sub-National and Country-level Predictors of Primary Cooking Fuel Switching in Nine Countries from the PURE Study. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2019; 14:085006. [PMID: 33777170 PMCID: PMC7995525 DOI: 10.1088/1748-9326/ab2d46] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Switching from polluting (e.g. wood, crop waste, coal) to clean cooking fuels (e.g. gas, electricity) can reduce household air pollution (HAP) exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. METHODS We examined longitudinal survey data from 24,172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology (PURE) study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (~2005-2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. RESULTS One-half of study households (12,369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7,582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3,109) switched between different polluting fuels, 10% (1,164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17,830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005-2015) were the strongest predictors of polluting-to-clean fuel switching. CONCLUSIONS The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mushtaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - KG Jayachtria
- St. John’s Medical College & Research Institute, Bangalore, India
| | - Prem K. Mony
- St. John’s Medical College & Research Institute, Bangalore, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - PVM Lakshmi
- School of Public Health, PGIMER, Chandigarh, India
| | - Vivek Sagar
- School of Public Health, PGIMER, Chandigarh, India
- Department of Community Medicine, PGIMER, Chandigarh, India
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Indu Mohan
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Sanjeev Nair
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - Ravi Prasad Varma
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
- Achutha Menon Centre for Health Science Studies, Trivandrum India
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Bo Hu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Kai You
- Shunyi District Center for Disease Prevention and Control, Beijing, China
| | - Tatenda Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | | | | | - Patricio Lopez-Jaramillo
- Research Department, FOSCAL and Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Paul A. Camacho
- Research Department, FOSCAL and Medical School, Universidad Autonoma de Bucaramanga (UNAB), Colombia
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Young BN, Peel JL, Benka-Coker ML, Rajkumar S, Walker ES, Brook RD, Nelson TL, Volckens J, L’Orange C, Good N, Quinn C, Keller JP, Weller ZD, Africano S, Osorto Pinel AB, Clark ML. Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health. BMC Public Health 2019; 19:903. [PMID: 31286921 PMCID: PMC6615088 DOI: 10.1186/s12889-019-7214-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24-59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM2.5) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM2.5 and indicators of cardiometabolic health. DISCUSSION This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02658383 , posted January 18, 2016, field work completed May 2018. Official title, "Community-Based Participatory Research: A Tool to Advance Cookstove Interventions." Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018.
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Affiliation(s)
- Bonnie N. Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Megan L. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
- Department of Health Sciences, Gettysburg College, Gettysburg, PA USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Casey Quinn
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
| | - Joshua P. Keller
- Department of Statistics, Colorado State University, Fort Collins, CO USA
| | - Zachary D. Weller
- Department of Statistics, Colorado State University, Fort Collins, CO USA
| | | | - Anibal B. Osorto Pinel
- Trees, Water & People, Fort Collins, CO USA
- Asociación Hondureña para el Desarrollo, Tegucigalpa, Honduras
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681 USA
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Champion WM, Grieshop AP. Pellet-Fed Gasifier Stoves Approach Gas-Stove Like Performance during in-Home Use in Rwanda. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:6570-6579. [PMID: 31037940 DOI: 10.1021/acs.est.9b00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Nearly all households in Rwanda burn solid fuels for cooking. A private firm in Rwanda is distributing forced-draft pellet-fed semigasifier cookstoves and fuel pellets. We measured in-use emissions of pollutants including fine particulate matter (PM2.5), organic and elemental carbon (OC, EC), black carbon (BC), and carbon monoxide (CO) in 91 uncontrolled cooking tests (UCTs) of both pellet and baseline (wood; charcoal) stoves. We observed >90% reductions in most pollutant emission factors/rates from pellet stoves compared to baseline stoves. Pellet stoves performed far better than gasifier stoves burning unprocessed wood, and consistent with ISO tiers 4 and 5 for PM2.5 and CO, respectively. Pellet stoves were generally clean, but performance varied; emissions from the dirtiest pellet tests matched those from the cleanest traditional stove tests. Our real-time data suggest that events occurring during ignition and the end of testing (e.g., refueling, char burnout) drive high emissions during pellet tests. We use our data to estimate potential health and climate cobenefits from stove adoption. This analysis suggests that pellet stoves have the potential to provide health benefits far above previously tested biomass stoves and approaching modern fuel stoves (e.g., LPG). Net climate impacts of pellet stoves range from similar to LPG to negligible, depending on biomass source and upstream emissions.
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Affiliation(s)
- Wyatt M Champion
- Department of Civil, Construction, and Environmental Engineering , North Carolina State University , Raleigh , North Carolina 27695 , United States
| | - Andrew P Grieshop
- Department of Civil, Construction, and Environmental Engineering , North Carolina State University , Raleigh , North Carolina 27695 , United States
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Pillarisetti A, Ghorpade M, Madhav S, Dhongade A, Roy S, Balakrishnan K, Sankar S, Patil R, Levine DI, Juvekar S, Smith KR. Promoting LPG usage during pregnancy: A pilot study in rural Maharashtra, India. ENVIRONMENT INTERNATIONAL 2019; 127:540-549. [PMID: 30981912 PMCID: PMC7213905 DOI: 10.1016/j.envint.2019.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 05/05/2023]
Abstract
Household air pollution from the combustion of biomass and coal is estimated to cause approximately 780,000 premature deaths a year in India. The government has responded by promoting uptake of liquefied petroleum gas (LPG) by tens of millions of poor rural families. Many poor households with new LPG stoves, however, continue to partially use traditional smoky chulhas. Our primary objective was to evaluate three strategies to transition pregnant women in rural Maharashtra to exclusive use of LPG for cooking. We also measured reductions in kitchen concentrations of PM2.5 before and after our interventions. Our core intervention was a free stove, 2 free LPG cylinders (one on loan until delivery), and repeated health messaging. We measured stove usage of both the traditional and intervention stoves until delivery. In households that received the core intervention, an average of 66% days had no indoor cooking on a chulha. In an adjacent area, we evaluated a conditional cash transfer (CCT) based on usage of LPG in addition to the core intervention. Results were less successful, due to challenges implementing the CCT. Pregnant women in a third nearby area received the core intervention plus a maximum of one 14.2 kg cylinder per month of free fuel. In their homes, 90% of days had no indoor cooking on a chulha. On average, exclusive LPG use decreased kitchen concentrations of PM2.5 by approximately 85% (from 520 to 72 μg/m3). 85% of participating households agreed to pay the deposit on the 2nd cylinder. This high purchase rate suggests they valued how the second cylinder permitted continuous LPG supply. A program to increase access to second cylinders may, thus, be a straightforward way to encourage use of clean fuels in rural areas.
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Affiliation(s)
- Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, United States.
| | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sathish Madhav
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sambandam Sankar
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - David I Levine
- Haas School of Business, University of California, Berkeley, CA 94720, United States
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, United States; Collaborative Clean Air Policy Centre, New Delhi, India
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Kirby MA, Nagel CL, Rosa G, Zambrano LD, Musafiri S, Ngirabega JDD, Thomas EA, Clasen T. Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda. PLoS Med 2019; 16:e1002812. [PMID: 31158266 PMCID: PMC6546207 DOI: 10.1371/journal.pmed.1002812] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 04/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION Clinical Trials.gov NCT02239250.
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Affiliation(s)
- Miles A. Kirby
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Corey L. Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ghislaine Rosa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura D. Zambrano
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sanctus Musafiri
- University of Rwanda School of Medicine and Pharmacy, Butare, Rwanda
| | - Jean de Dieu Ngirabega
- Rwanda Biomedical Center, Kigali, Rwanda
- East African Health Research Commission, Arusha, United Republic of Tanzania
| | - Evan A. Thomas
- Mortenson Center in Global Engineering, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Thomas Clasen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Abstract
This paper presents results from eight field studies in Asia and Africa on the emissions performance of 16 stove/fuel combinations measured during normal cooking events in homes. Characterizing real-world emissions performance is important for understanding the climate and health implications of technologies being promoted as alternatives to displace baseline cooking stoves and fuels. Almost all of the stove interventions were measured to have substantial reductions in PM2.5 and CO emissions compared to their respective baseline technologies (reductions of 24–87% and 25–80%, for PM2.5 and CO emission rates, respectively), though comparison with performance guidance from the World Health Organization (WHO) and the International Organization for Standardization (ISO) suggests that further improvement for biomass stoves would help realize more health benefits. The emissions of LPG stoves were generally below the WHO interim PM2.5 emissions target (1.75 mg/min) though it was not clear how close they were to the most aspirational ISO (0.2 mg/min) or WHO (0.23 mg/min) targets as our limit of detection was 1.1 mg/min. Elemental and organic carbon emission factors and elemental-to-total carbon ratios (medians ranging from 0.11 to 0.42) were in line with previously reported field-based estimates for similar stove/fuel combinations. Two of the better performing forced draft stoves used with pellets—the Oorja (median ET/TC = 0.12) and Eco-Chula (median ET/TC = 0.42)—were at opposite ends of the range, indicating that important differences in combustion conditions can arise even between similar stove/fuel combinations. Field-based tests of stove performance also provide important feedback for laboratory test protocols. Comparison of these results to previously published water boiling test data from the laboratory reinforce the trend that stove performance is generally better during controlled laboratory conditions, with modified combustion efficiency (MCE) being consistently lower in the field for respective stove/fuel categories. New testing approaches, which operate stoves through a broader range of conditions, indicate potential for better MCE agreement than previous versions of water boiling tests. This improved agreement suggests that stove performance estimates from a new ISO laboratory testing protocol, including testing stoves across low, medium, and high firepower, may provide more representative estimates of real-world performance than previously used tests. More representative results from standardized laboratory testing should help push stove designs toward better real-world performance as well as provide a better indication of how the tested technologies will perform for the user.
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Modeling the Impact of an Indoor Air Filter on Air Pollution Exposure Reduction and Associated Mortality in Urban Delhi Household. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081391. [PMID: 30999693 PMCID: PMC6518106 DOI: 10.3390/ijerph16081391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/13/2019] [Accepted: 04/14/2019] [Indexed: 11/16/2022]
Abstract
Indoor exposure to fine particulate matter (PM2.5) is a prominent health concern. However, few studies have examined the effectiveness of long-term use of indoor air filters for reduction of PM2.5 exposure and associated decrease in adverse health impacts in urban India. We conducted 20 simulations of yearlong personal exposure to PM2.5 in urban Delhi using the National Institute of Standards and Technology's CONTAM program (NIST, Gaithersburg, MD, USA). Simulation scenarios were developed to examine different air filter efficiencies, use schedules, and the influence of a smoker at home. We quantified associated mortality reductions with Household Air Pollution Intervention Tool (HAPIT, University of California, Berkeley, CA, USA). Without an air filter, we estimated an annual mean PM2.5 personal exposure of 103 µg/m3 (95% Confidence Interval (CI): 93, 112) and 137 µg/m3 (95% CI: 125, 149) for households without and with a smoker, respectively. All day use of a high-efficiency particle air (HEPA) filter would reduce personal PM2.5 exposure to 29 µg/m3 and 30 µg/m3, respectively. The reduced personal PM2.5 exposure from air filter use is associated with 8-37% reduction in mortality attributable to PM2.5 pollution in Delhi. The findings of this study indicate that air filter may provide significant improvements in indoor air quality and result in health benefits.
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Nyombi A, Williams M, Wessling R. Mechanical impregnation of Pd-Sn/alumina and Cu-Mn/graphite on charcoal to minimise carbon monoxide emissions. Chem Phys Lett 2019. [DOI: 10.1016/j.cplett.2018.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pillarisetti A, Gill M, Allen T, Madhavan S, Dhongade A, Ghorpade M, Roy S, Balakrishnan K, Juvekar S, Smith KR. A Low-Cost Stove Use Monitor to Enable Conditional Cash Transfers. ECOHEALTH 2018; 15:768-776. [PMID: 30315510 DOI: 10.1007/s10393-018-1379-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/30/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
Conditional cash transfers (CCTs)-cash payments provided to households or specific household members who meet defined conditions or fulfill certain behaviors-have been extensively used in India to encourage antenatal care, institutional delivery, and vaccination. This paper describes the social design and technical development of a low-cost, meal-counting stove use monitor (the Pink Key) that enables a CCT based on liquefied petroleum gas (LPG) usage and presents pilot data from its testing and the initial deployment. The system consists of a sensing harness attached to a two-burner LPG stove and an easily removable datalogger. For each cooking event with LPG, households receive 2 rupees-less than the cost of fuel, but enough to partially defray LPG refill costs. The system could enable innovative "self-monitoring" at a large scale-participants initiate the CCT by bringing their Pink Key to antenatal clinic visits, where care providers download data and initiate payments, and participants return the sensor to their stove at home. The system aligns with existing Indian programs to improve health among poor, pregnant women, and contributes a new method to encourage the use of clean cooking technologies.
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Affiliation(s)
- Ajay Pillarisetti
- Environmental Health Sciences, School of Public Health, University of California, Berkeley Way West, Berkeley, CA, 94720, USA.
| | - Manpreet Gill
- Electronically Monitored Ecosystems, LLC, Berkeley, CA, USA
| | - Tracy Allen
- Electronically Monitored Ecosystems, LLC, Berkeley, CA, USA
| | - Sathish Madhavan
- Sri Ramachandra Medical College and Research Institute (Deemed to be University), Chennai, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- Sri Ramachandra Medical College and Research Institute (Deemed to be University), Chennai, India
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kirk R Smith
- Environmental Health Sciences, School of Public Health, University of California, Berkeley Way West, Berkeley, CA, 94720, USA
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Petach H, Williams KN, Mehta S. Social, Ecological, and Health Benefits of Clean Cooking. ECOHEALTH 2018; 15:713-715. [PMID: 30083856 DOI: 10.1007/s10393-018-1340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Helen Petach
- Bureau of Global Health, Office of Maternal, Child Health, and Nutrition, United States Agency for International Development (USAID), Washington, DC, USA
| | - Kendra N Williams
- University Research Co., LLC, Bethesda, MD, USA.
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, E5527, Baltimore, MD, 21205, USA.
| | - Sumi Mehta
- Environmental Health Division, Vital Strategies, New York, NY, USA
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44
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Drivers and Barriers to Clean Cooking: A Systematic Literature Review from a Consumer Behavior Perspective. SUSTAINABILITY 2018. [DOI: 10.3390/su10114322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A lack of access to clean energy and use of traditional cooking systems have severe negative effects on health, especially among women and children, and on the environment. Despite increasing attention toward this topic, few studies have explored the factors influencing consumers’ adoption of improved cooking stoves (ICS). This systematic literature review (n = 81) aims to identify the main drivers and barriers to clean cooking from a consumer perspective. In addition, it aims to define how consumers perceive ICS with respect to traditional stoves. Thematic analysis revealed seven factors that may act as drivers or barriers to ICS adoption: economic factors; socio-demographics; fuel availability; attitude toward technology; awareness of the risks of traditional cookstoves and the benefits of ICS; location; and social and cultural influences. Perceptions focused on four topics: convenience and uses, aesthetics, health-related impacts, and environmental impacts. This review contributes to understanding of consumer behavior with regards to ICS. The findings suggest that availability and affordability of technology are not enough to enhance ICS adoption. Rather, policy makers and managers should approach customers with a less technical and a more personalized approach that takes due consideration of a local context and its social and cultural dynamics.
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Du W, Zhu X, Chen Y, Liu W, Wang W, Shen G, Tao S, Jetter JJ. Field-based emission measurements of biomass burning in typical Chinese built-in-place stoves. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 242:1587-1597. [PMID: 30097283 PMCID: PMC6262877 DOI: 10.1016/j.envpol.2018.07.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 05/05/2023]
Abstract
Residential combustion emission contributes significantly to ambient and indoor air pollution in China; however, this pollution source is poorly characterized and often overlooked in national pollution control policies. Few studies, and even fewer field-based investigations, have evaluated pollutant emissions from indoor biomass burning. One significant feature of Chinese household biofuel stoves is that many are built on site. In this study, 112 tests were conducted to investigate pollutant emission factors and variations for 11 fuel-stove combinations in actual use in the field. Results showed that, compared to those emission tests under controlled fuel burning conditions, EFs of methane, sulfur dioxide, particulate matter, and organic carbon from the field-based uncontrolled tests were higher, but carbon monoxide, nitrogen oxides, and elemental carbon were not significantly different. Controlled burning tests may be unrepresentative of real-world fuel burning. Pollutant emissions from uncontrolled burning tests had much higher variations compared with controlled tests. Most pollutant emissions from indoor straw burning are higher than that in open burning, except nitrogen oxides. The typical built-in-place home stoves in China had low efficiencies and high pollutant emissions that were rated as Tier 0 (the worst) or Tier 1 of a four-tier scale according to the International Organization for Standardization, International Workshop Agreement 11-2012. Effective interventions are expected to lower pollutant emissions from residential combustion to improve air quality and to protect human health.
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Affiliation(s)
- Wei Du
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Xi Zhu
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Yuanchen Chen
- College of Environment, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Weijian Liu
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Wei Wang
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Guofeng Shen
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China; Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow at U.S. Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, 27709, USA.
| | - Shu Tao
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - James J Jetter
- U.S. Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, 27709, USA
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46
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Gould CF, Urpelainen J. LPG as a Clean Cooking Fuel: Adoption, Use, and Impact in Rural India. ENERGY POLICY 2018; 122:395-408. [PMID: 32581420 PMCID: PMC7314235 DOI: 10.1016/j.enpol.2018.07.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Liquefied petroleum gas (LPG) is by far the most popular clean cooking fuel in rural India, but how rural households use it remains poorly understood. Using the 2014-2015 ACCESS survey with over 8,500 households from six energy-poor Indian states, we offer a broad but detailed survey of LPG use in rural India. We find that (i) fuel costs are a critical obstacle to widespread adoption, (ii) fuel stacking is the prevailing norm as few households stop using firewood when adopting LPG, and (iii) both users and non-users have highly positive views of LPG as a convenient and clean cooking fuel. These findings show that expanding LPG use offers great promise in rural India, but affordability prevents a complete transition from traditional biomass to clean cooking fuels.
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Aung TW, Baumgartner J, Jain G, Sethuraman K, Reynolds C, Marshall JD, Brauer M. Effect on blood pressure and eye health symptoms in a climate-financed randomized cookstove intervention study in rural India. ENVIRONMENTAL RESEARCH 2018; 166:658-667. [PMID: 30015250 DOI: 10.1016/j.envres.2018.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Air pollution from cooking with solid fuels is a potentially modifiable risk factor for increased blood pressure and may lead to eye irritation. OBJECTIVES To evaluate whether a climate motivated cookstove intervention reduced blood pressure and eye irritation symptoms in Indian women. METHODS Households using traditional stoves were randomized to receive a rocket stove or continue using traditional stoves. Systolic (SBP) and diastolic blood pressure (DBP), and self-reported eye symptoms were measured twice, pre-intervention and at least 124 days post-intervention in women > 25 years old in control (N = 111) and intervention (N = 111) groups in rural Karnataka, India. Daily (24-h) fine particle (PM2.5) mass and absorbance (Abs) were measured in cooking areas at each visit. Mixed-effect models were used to estimate before-and-after differences in SBP, DBP and eye symptoms. RESULTS We observed a lower SBP (-2.0 (-4.5, 0.5) mmHg) and DBP (-1.1 (-2.9, 0.6) mmHg) among exclusive users of intervention stove, although confidence intervals included zero. Stacking or mixed use of intervention and traditional stoves contributed to a small increase in SBP 2.6 (-0.4, 5.7) mmHg) and DBP (1.2 (-0.9, 3.3) mmHg). Exclusive and mixed stove users experienced higher post-intervention reductions, on average, in self-reported eye irritation symptoms for burning sensation in eyes, and eyes look red often compared to control. Median air pollutant concentrations increased post-intervention in all stove groups, with the lowest median PM2.5 increase in the exclusive intervention stove group. CONCLUSIONS Health benefits were limited due to stacking and lower-than-predicted efficiency of the intervention stove in the field. Stove adoption and use behavior, in addition to stove technology, affects achievement of health co-benefits. Carbon-financing schemes need to align with international guidelines that have been set based on health outcomes to maximize health co-benefits from cookstove interventions.
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Affiliation(s)
- Ther W Aung
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4.
| | - Jill Baumgartner
- Institute for Health & Social Policy and Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Charles Meredith House, Room B7, Montreal, Quebec, Canada.
| | - Grishma Jain
- Resource Optimization Initiative, No. 66, 1st Cross, Domlur Layout, Bangalore 560071, Karnataka, India.
| | - Karthik Sethuraman
- Resource Optimization Initiative, No. 66, 1st Cross, Domlur Layout, Bangalore 560071, Karnataka, India.
| | - Conor Reynolds
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4.
| | - Julian D Marshall
- Civil and Environmental Engineering, University of Washington, Wilcox 268, Seattle, WA, USA.
| | - Michael Brauer
- Institute for Resources, Environment and Sustainability, University of British Columbia, 429-2202 Main Mall, Vancouver, BC, Canada V6T 1Z4; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3.
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Pollard SL, Williams KN, O'Brien CJ, Winiker A, Puzzolo E, Kephart JL, Fandiño-Del-Rio M, Tarazona-Meza C, Grigsby M, Chiang M, Checkley W. An evaluation of the Fondo de Inclusión Social Energético program to promote access to liquefied petroleum gas in Peru. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2018; 46:82-93. [PMID: 30364502 PMCID: PMC6197055 DOI: 10.1016/j.esd.2018.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Over 80% of rural households in Peru use solid fuels as their primary source of domestic energy, which contributes to several health problems. In 2016, 6.7 million Peruvians were living in rural areas. The Fondo de Inclusión Social Energético (FISE) LPG Promotion Program, which began in 2012 and is housed under the Ministry of Energy and Mining, is a government-sponsored initiative aimed at reducing use of solid fuels by increasing access to clean fuel for cooking to poor Peruvian households. METHODS We conducted a mixed methods study incorporating data from publicly available records and reports, a community survey of 375 households in Puno (the province with the largest number of FISE beneficiary households), and in-depth interviews with community members and key stakeholders. We used the Reach, Effectiveness - Adoption, Implementation, Maintenance (RE-AIM) framework to guide our data collection and analysis efforts. In a sample of 95 households, we also measured 48-hour area concentrations and personal exposures to fine particulate matter (PM2.5). RESULTS The FISE LPG promotion program has achieved high geographical reach; the program is currently serving households in 100% of districts in Peru. Households with access to electricity may be participating at a higher level than households without electricity because the program is implemented primarily by electricity distributors. In a sample of 95 households, FISE beneficiaries experienced a reduction in kitchen concentrations of PM2.5; however, there were no differences in personal exposures, and both kitchen and personal exposures were above the WHO intermediate target for indoor air quality. Among the 375 households surveyed, stove stacking with biomass fuels was reported in more than 95% of both beneficiary and non-beneficiary households, with fewer than 5% reporting exclusive use. In-depth interviews suggest that the complexity of enrollment process and access to LPG distribution points may be key barriers to participating in FISE. CONCLUSION The FISE LPG Program has achieved high reach and its targeted subsidy and surcharge-based financing structure represent a potentially feasible and sustainable model for other government programs. However, the prevalence of stove stacking among FISE beneficiaries remains high. There is a need for improved communication channels between program implementers and beneficiaries. FISE should also consider expanding the mobile LPG network and community delivery service to reduce physical barriers and indirect costs of LPG acquisition. Finally, increasing the value of LPG vouchers to completely cover one or two tanks a month, or alternatively, introducing behavior change strategies to reduce monthly LPG usage, may facilitate the transition to exclusive LPG use.
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Affiliation(s)
- Suzanne L Pollard
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Kendra N Williams
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Carolyn J O'Brien
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Abigail Winiker
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Elisa Puzzolo
- Department of Public Health and Policy, the University of Liverpool, United Kingdom
- The Global LPG Partnership, New York, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | - Matthew Grigsby
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | | | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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49
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Snider G, Carter E, Clark S, Tseng JTW, Yang X, Ezzati M, Schauer JJ, Wiedinmyer C, Baumgartner J. Impacts of stove use patterns and outdoor air quality on household air pollution and cardiovascular mortality in southwestern China. ENVIRONMENT INTERNATIONAL 2018; 117:116-124. [PMID: 29734062 PMCID: PMC7615186 DOI: 10.1016/j.envint.2018.04.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/28/2018] [Accepted: 04/27/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Decades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified. METHODS We measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships. RESULTS Mean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced. CONCLUSIONS Clean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.
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Affiliation(s)
- Graydon Snider
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Ellison Carter
- Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
| | - Sierra Clark
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Joy Tzu Wei Tseng
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - James J Schauer
- Environmental Chemistry and Technology Program, University of Wisconsin, Madison, WI, USA; Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, WI, USA
| | | | - Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada; Institute on the Environment, University of Minnesota, St. Paul, MN, USA.
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50
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Abstract
Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.
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Affiliation(s)
- Michael B Hadley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.B.H.)
| | - Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
| | - Rajesh Vedanthan
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
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