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Younger A, Ye W, Alkon A, Harknett K, Kirby MA, Elon L, Lovvorn AE, Wang J, Diaz-Artiga A, McCracken JP, Castañaza Gonzalez A, Alarcon LM, Mukeshimana A, Rosa G, Chiang M, Balakrishnan K, Garg SS, Pillarisetti A, Piedrahita R, Johnson MA, Craik R, Papageorghiou AT, Toenjes A, Williams KN, Underhill LJ, Hartinger SM, Nicolaou L, Chang HH, Naeher LP, Rosenthal J, Checkley W, Peel JL, Clasen TF, Thompson LM. Effects of a liquefied petroleum gas stove intervention on stillbirth, congenital anomalies and neonatal mortality: A multi-country household air pollution intervention network trial. Environ Pollut 2024; 345:123414. [PMID: 38286258 DOI: 10.1016/j.envpol.2024.123414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to <35 years of age; gestation confirmed by ultrasound at 9 to <20 weeks) were randomly assigned to intervention or control arms. We monitored these fetal and neonatal outcomes and personal exposure to PM2.5, BC and CO three times during pregnancy, we conducted intention-to-treat (ITT) and exposure-response (E-R) analyses to determine if the HAPIN intervention and corresponding HAP exposure was associated with the risk of fetal/neonatal outcomes. A total of 3200 women (mean age 25.4 ± 4.4 years, mean gestational age at randomization 15.4 ± 3.1 weeks) were included in this analysis. Relative risks for stillbirth, congenital anomaly and neonatal mortality were 0.99 (0.60, 1.66), 0.92 (95 % CI 0.52, 1.61), and 0.99 (0.54, 1.85), respectively, among women in the intervention arm compared to controls in an ITT analysis. Higher mean personal exposures to PM2.5, CO and BC during pregnancy were associated with a higher, but statistically non-significant, incidence of adverse outcomes. The LPG stove and fuel intervention did not reduce the risk of these outcomes nor did we find evidence supporting an association between personal exposures to HAP and stillbirth, congenital anomalies and neonatal mortality.
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Affiliation(s)
- Ashley Younger
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Wenlu Ye
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Abbey Alkon
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kristen Harknett
- School of Nursing, University of California, San Francisco, CA, USA
| | - Miles A Kirby
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy E Lovvorn
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anaité Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala; Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Libny Monroy Alarcon
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Ghislaine Rosa
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Marilu Chiang
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada S Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | - Rachel Craik
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Ashley Toenjes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kendra N Williams
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lindsay J Underhill
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stella M Hartinger
- Latin American Center of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
| | - Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global 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 F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA
| | - Lisa M Thompson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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McCollum ED, McCracken JP, Kirby MA, Grajeda LM, Hossen S, Moulton LH, Simkovich SM, Goodman-Palmer D, Rosa G, Mukeshimana A, Balakrishnan K, Thangavel G, Garg SS, Castañaza A, Thompson LM, Diaz-Artiga A, Papageorghiou AT, Davila-Roman VG, Underhill LJ, Hartinger SM, Williams KN, Nicolaou L, Chang HH, Lovvorn AE, Rosenthal JP, Pillarisetti A, Ye W, Naeher LP, Johnson MA, Waller LA, Jabbarzadeh S, Wang J, Chen Y, Steenland K, Clasen TF, Peel JL, Checkley W. Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia. N Engl J Med 2024; 390:32-43. [PMID: 38169488 PMCID: PMC10768798 DOI: 10.1056/nejmoa2305681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Exposure to household air pollution is a risk factor for severe pneumonia. The effect of replacing biomass cookstoves with liquefied petroleum gas (LPG) cookstoves on the incidence of severe infant pneumonia is uncertain. METHODS We conducted a randomized, controlled trial involving pregnant women 18 to 34 years of age and between 9 to less than 20 weeks' gestation in India, Guatemala, Peru, and Rwanda from May 2018 through September 2021. The women were assigned to cook with unvented LPG stoves and fuel (intervention group) or to continue cooking with biomass fuel (control group). In each trial group, we monitored adherence to the use of the assigned cookstove and measured 24-hour personal exposure to fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) in the women and their offspring. The trial had four primary outcomes; the primary outcome for which data are presented in the current report was severe pneumonia in the first year of life, as identified through facility surveillance or on verbal autopsy. RESULTS Among 3200 pregnant women who had undergone randomization, 3195 remained eligible and gave birth to 3061 infants (1536 in the intervention group and 1525 in the control group). High uptake of the intervention led to a reduction in personal exposure to PM2.5 among the children, with a median exposure of 24.2 μg per cubic meter (interquartile range, 17.8 to 36.4) in the intervention group and 66.0 μg per cubic meter (interquartile range, 35.2 to 132.0) in the control group. A total of 175 episodes of severe pneumonia were identified during the first year of life, with an incidence of 5.67 cases per 100 child-years (95% confidence interval [CI], 4.55 to 7.07) in the intervention group and 6.06 cases per 100 child-years (95% CI, 4.81 to 7.62) in the control group (incidence rate ratio, 0.96; 98.75% CI, 0.64 to 1.44; P = 0.81). No severe adverse events were reported to be associated with the intervention, as determined by the trial investigators. CONCLUSIONS The incidence of severe pneumonia among infants did not differ significantly between those whose mothers were assigned to cook with LPG stoves and fuel and those whose mothers were assigned to continue cooking with biomass stoves. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.).
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Affiliation(s)
- Eric D McCollum
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - John P McCracken
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Miles A Kirby
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Laura M Grajeda
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shakir Hossen
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lawrence H Moulton
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Suzanne M Simkovich
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Dina Goodman-Palmer
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ghislaine Rosa
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Alexie Mukeshimana
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kalpana Balakrishnan
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Gurusamy Thangavel
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Sarada S Garg
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Adly Castañaza
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lisa M Thompson
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Anaite Diaz-Artiga
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Aris T Papageorghiou
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Victor G Davila-Roman
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lindsay J Underhill
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Stella M Hartinger
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kendra N Williams
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Laura Nicolaou
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Howard H Chang
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Amy E Lovvorn
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Joshua P Rosenthal
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ajay Pillarisetti
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Wenlu Ye
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Luke P Naeher
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Michael A Johnson
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lance A Waller
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shirin Jabbarzadeh
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jiantong Wang
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Yunyun Chen
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kyle Steenland
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Thomas F Clasen
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jennifer L Peel
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - William Checkley
- From the Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences (E.D.M.), the Division of Pulmonary and Critical Care (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Center for Global Non-Communicable Disease Research and Training, School of Medicine (S.H., S.M.S., D.G.-P., S.M.H., K.N.W., L.N., W.C.), and the Department of International Health (E.D.M.) and the Program in Global Disease Epidemiology and Control, Department of International Health (L.H.M.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville (S.M.S.), and Fogarty International Center, National Institutes of Health, Bethesda (J.P.R.) - all in Maryland; the Global Health Institute, Department of Epidemiology and Biostatistics (J.P.M., L.M.G.), and the Department of Environmental Health Science, College of Public Health (L.P.N.), University of Georgia, Athens, and the Department of Biostatistics and Bioinformatics (H.H.C., L.A.W., S.J., J.W., Y.C.) and the Gangarosa Department of Environmental Health (A.E.L., K.S., T.F.C.), Rollins School of Public Health, and the Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta - both in Georgia; the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City (J.P.M., L.M.G., A.C., A.D.-A.); the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington DC (S.M.S.); the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India (K.B., G.T., S.S.G.); the Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R., L.J.U.); the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.P., W.Y.), and Berkeley Air Monitoring Group (M.A.J.) - both in Berkeley, CA; and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
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Checkley W, Thompson LM, Sinharoy SS, Hossen S, Moulton LH, Chang HH, Waller L, Steenland K, Rosa G, Mukeshimana A, Ndagijimana F, McCracken JP, Díaz-Artiga A, Balakrishnan K, Garg SS, Thangavel G, Aravindalochanan V, Hartinger SM, Chiang M, Kirby MA, Papageorghiou AT, Ramakrishnan U, Williams KN, Nicolaou L, Johnson M, Pillarisetti A, Rosenthal J, Underhill LJ, Wang J, Jabbarzadeh S, Chen Y, Dávila-Román VG, Naeher LP, McCollum ED, Peel JL, Clasen TF. Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants. N Engl J Med 2024; 390:44-54. [PMID: 38169489 DOI: 10.1056/nejmoa2302687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Household air pollution is associated with stunted growth in infants. Whether the replacement of biomass fuel (e.g., wood, dung, or agricultural crop waste) with liquefied petroleum gas (LPG) for cooking can reduce the risk of stunting is unknown. METHODS We conducted a randomized trial involving 3200 pregnant women 18 to 34 years of age in four low- and middle-income countries. Women at 9 to less than 20 weeks' gestation were randomly assigned to use a free LPG cookstove with continuous free fuel delivery for 18 months (intervention group) or to continue using a biomass cookstove (control group). The length of each infant was measured at 12 months of age, and personal exposures to fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm) were monitored starting at pregnancy and continuing until the infants were 1 year of age. The primary outcome for which data are presented in the current report - stunting (defined as a length-for-age z score that was more than two standard deviations below the median of a growth standard) at 12 months of age - was one of four primary outcomes of the trial. Intention-to-treat analyses were performed to estimate the relative risk of stunting. RESULTS Adherence to the intervention was high, and the intervention resulted in lower prenatal and postnatal 24-hour personal exposures to fine particulate matter than the control (mean prenatal exposure, 35.0 μg per cubic meter vs. 103.3 μg per cubic meter; mean postnatal exposure, 37.9 μg per cubic meter vs. 109.2 μg per cubic meter). Among 3061 live births, 1171 (76.2%) of the 1536 infants born to women in the intervention group and 1186 (77.8%) of the 1525 infants born to women in the control group had a valid length measurement at 12 months of age. Stunting occurred in 321 of the 1171 infants included in the analysis (27.4%) of the infants born to women in the intervention group and in 299 of the 1186 infants included in the analysis (25.2%) of those born to women in the control group (relative risk, 1.10; 98.75% confidence interval, 0.94 to 1.29; P = 0.12). CONCLUSIONS An intervention strategy starting in pregnancy and aimed at mitigating household air pollution by replacing biomass fuel with LPG for cooking did not reduce the risk of stunting in infants. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.).
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Affiliation(s)
- William Checkley
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lisa M Thompson
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Sheela S Sinharoy
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shakir Hossen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lawrence H Moulton
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Howard H Chang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lance Waller
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kyle Steenland
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ghislaine Rosa
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Alexie Mukeshimana
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Florien Ndagijimana
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - John P McCracken
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Anaité Díaz-Artiga
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kalpana Balakrishnan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Sarada S Garg
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Gurusamy Thangavel
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Vigneswari Aravindalochanan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Stella M Hartinger
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Marilú Chiang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Miles A Kirby
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Aris T Papageorghiou
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Usha Ramakrishnan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kendra N Williams
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Laura Nicolaou
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Michael Johnson
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ajay Pillarisetti
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Joshua Rosenthal
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lindsay J Underhill
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jiantong Wang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shirin Jabbarzadeh
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Yunyun Chen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Victor G Dávila-Román
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Luke P Naeher
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Eric D McCollum
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jennifer L Peel
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Thomas F Clasen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research 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 (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
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Fujita-Conrads R, Williams KN, Underhill LJ, Herrera P, Rahman N, Romani-Huacani E, Flores-Flores O, Checkley W, Pollard SL. Successes and challenges to implementing the Fondo de Inclusión Social Energético LPG access Program in Peru: novel insights from front-end implementers. Energy Sustain Dev 2023; 76:101267. [PMID: 37484495 PMCID: PMC10361398 DOI: 10.1016/j.esd.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Household air pollution due to the burning of solid fuels is one of the leading risk factors for disease and mortality worldwide, resulting in an estimated three million deaths annually. Peru's national LPG access program, FISE, aims to reduce the use of biomass fuels and increase access to cleaner fuels for cooking in low-income Peruvian households through public-private partnerships. Perspectives from front-end program implementers are needed to better understand barriers and facilitators to program implementation and to identify strategies to strengthen program reach, uptake, and health impact. Methods We conducted fourteen 30-60-minute, semi-structured interviews with FISE-authorized LPG vendors (also known as agents) in Puno, Peru from November to December of 2019. Questions focused on barriers and facilitators to program enrollment and participation as an LPG agent, and agents' motivations for participating in the program. Results Overall, agents expressed satisfaction with the FISE program and a willingness to continue participating in the program. Distance from main cities and the homes of program participants, knowledge of FISE and LPG stoves among community members, cell service, and lack of communication with FISE authorities were cited as barriers to implementation and LPG distribution. Agents' previous experience selling LPG, as well as their social networks and understanding of the health impacts of household air pollution, aided agents in more effectively navigating the system of FISE rules and regulations and in better serving their clients. Many agents were motivated to participate in FISE because they saw it as a service to their community and were willing to find ways to prioritize the needs of beneficiaries. Conclusion The FISE program provides an example of how a large-scale national program can successfully partner with local private enterprises for program implementation. Building upon the strengths of community-based LPG agents, educating community members on the use and benefits of LPG, incentivizing, and supporting delivery services, and improving communication will be key for increasing program utilization and exclusive use of LPG, and improving health outcomes among Peru's most vulnerable populations.
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Affiliation(s)
- Ryanne Fujita-Conrads
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Kendra N Williams
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Lindsay J Underhill
- Division of Cardiology, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Phabiola Herrera
- Division of Pulmonary, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nihaal Rahman
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
| | | | - Oscar Flores-Flores
- Universidad de San Martín de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Suzanne L Pollard
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
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5
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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. Environ Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pillarisetti A, Ye W, Balakrishnan K, Rosa G, Díaz-Artiga A, Underhill LJ, Steenland K, Peel JL, Kirby MA, McCracken J, Waller L, Chang H, Wang J, Dusabimana E, Ndagijimana F, Sambandam S, Mukhopadhyay K, Kearns KA, Campbell D, Kremer J, Rosenthal J, Ghosh A, Clark M, Checkley W, Clasen T, Naeher L, Piedrahita R, Johnson M. Post-birth exposure contrasts for children during the Household Air Pollution Intervention Network randomized controlled trial. medRxiv 2023:2023.07.04.23292226. [PMID: 37461598 PMCID: PMC10350133 DOI: 10.1101/2023.07.04.23292226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Exposure to household air pollution is a leading cause of ill-health globally. The Household Air Pollution Intervention Network (HAPIN) randomized controlled trial evaluated the impact of a free liquefied petroleum gas stove and fuel intervention on birth outcomes and maternal and child health. As part of HAPIN, an extensive exposure assessment was conducted. Here, we report on PM 2.5 and CO exposures of young children (≤ 15 months old) reconstructed using a Bluetooth-beacon based time-activity monitoring system coupled with microenvironmental pollutant monitors. Median (IQR) exposures to PM 2.5 were 65.1 (33 - 128.2) µg/m 3 in the control group and 22.9 (17.2 - 35.3) µg/m3 in the intervention group; for CO, median (IQR) exposures were 1.1 (0.3 - 2.9) ppm and 0.2 (0 - 0.7) ppm for control and intervention group, respectively. Exposure reductions were stable over time and consistent with previous findings for the children's mothers. In the intervention group, 75% of children's reconstructed exposures were below the WHO interim target guideline value of 35 µg/m 3 , while 26% were below the standard in the control group. Our findings suggest that an LPG fuel and stove intervention can substantially reduce children's exposure to household air pollution.
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7
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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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Balakrishnan K, Steenland K, Clasen T, Chang H, Johnson M, Pillarisetti A, Ye W, Naeher LP, Diaz-Artiga A, McCracken JP, Thompson LM, Rosa G, Kirby MA, Thangavel G, Sambandam S, Mukhopadhyay K, Puttaswamy N, Aravindalochanan V, Garg S, Ndagijimana F, Hartinger S, Underhill LJ, Kearns KA, Campbell D, Kremer J, Waller L, Jabbarzadeh S, Wang J, Chen Y, Rosenthal J, Quinn A, Papageorghiou AT, Ramakrishnan U, Howards PP, Checkley W, Peel JL. Exposure-response relationships for personal exposure to fine particulate matter (PM 2·5), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial. Lancet Planet Health 2023; 7:e387-e396. [PMID: 37164515 PMCID: PMC10186177 DOI: 10.1016/s2542-5196(23)00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Household air pollution (HAP) from solid fuel use is associated with adverse birth outcomes, but data for exposure-response relationships are scarce. We examined associations between HAP exposures and birthweight in rural Guatemala, India, Peru, and Rwanda during the Household Air Pollution Intervention Network (HAPIN) trial. METHODS The HAPIN trial recruited pregnant women (9-<20 weeks of gestation) in rural Guatemala, India, Peru, and Rwanda and randomly allocated them to receive a liquefied petroleum gas stove or not (ie, and continue to use biomass fuel). The primary outcomes were birthweight, length-for-age, severe pneumonia, and maternal systolic blood pressure. In this exposure-response subanalysis, we measured 24-h personal exposures to PM2·5, carbon monoxide, and black carbon once pre-intervention (baseline) and twice post-intervention (at 24-28 weeks and 32-36 weeks of gestation), as well as birthweight within 24 h of birth. We examined the relationship between the average prenatal exposure and birthweight or weight-for-gestational age Z scores using multivariate-regression models, controlling for the mother's age, nulliparity, diet diversity, food insecurity, BMI, the mother's education, neonate sex, haemoglobin, second-hand smoke, and geographical indicator for randomisation strata. FINDINGS Between March, 2018, and February, 2020, 3200 pregnant women were recruited. An interquartile increase in the average prenatal exposure to PM2·5 (74·5 μg/m3) was associated with a reduction in birthweight and gestational age Z scores (birthweight: -14·8 g [95% CI -28·7 to -0·8]; gestational age Z scores: -0·03 [-0·06 to 0·00]), as was an interquartile increase in black carbon (7·3 μg/m3; -21·9 g [-37·7 to -6·1]; -0·05 [-0·08 to -0·01]). Carbon monoxide exposure was not associated with these outcomes (1·7; -3·1 [-12·1 to 5·8]; -0·003 [-0·023 to 0·017]). INTERPRETATION Continuing efforts are needed to reduce HAP exposure alongside other drivers of low birthweight in low-income and middle-income countries. FUNDING US National Institutes of Health (1UM1HL134590) and the Bill & Melinda Gates Foundation (OPP1131279).
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Affiliation(s)
- Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Wenlu Ye
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Luke P Naeher
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - John P McCracken
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Lisa M Thompson
- Rollins School of Public Health and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miles A Kirby
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Naveen Puttaswamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Vigneswari Aravindalochanan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | | | - Stella Hartinger
- Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Lindsay J Underhill
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA
| | - Katherine A Kearns
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Devan Campbell
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Jacob Kremer
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Lance Waller
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Rajamani KD, Sambandam S, Mukhopadhyay K, Puttaswamy N, Thangavel G, Natesan D, Ramasamy R, Sendhil S, Natarajan A, Aravindalochan V, Pillarisetti A, Johnson M, Rosenthal J, Steenland K, Piedhrahita R, Peel J, Clark ML, Boyd Barr D, Rajkumar S, Young B, Jabbarzadeh S, Rosa G, Kirby M, Underhill LJ, Diaz-Artiga A, Lovvorn A, Checkley W, Clasen T, Balakrishnan K. Visualizing Field Data Collection Procedures of Exposure and Biomarker Assessments for the Household Air Pollution Intervention Network Trial in India. J Vis Exp 2022. [PMID: 36622010 DOI: 10.3791/64144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Here, we present a visual representation of standard procedures to collect population-level data on personal exposures to household air pollution (HAP) from two different study sites in a resource-constrained setting of Tamil Nadu, India. Particulate matter PM2.5 (particles smaller than 2.5 microns in aerodynamic diameter), carbon monoxide (CO), and black carbon (BC) were measured in pregnant mothers (M), other adult women (OAW), and children (C) at various times over a 4 year period. In addition, stove usage monitoring (SUMs) with data-logging thermometers and ambient measurements of air pollution were carried out. Furthermore, the feasibility of collecting biological samples (urine and dried blood spots [DBSs]) from study participants at the field sites was successfully demonstrated. Based on findings from this and earlier studies, the methods used here have enhanced the data quality and avoided issues with household air pollution and biological sample collection in resource-constrained situations. The procedures established may be a valuable educational tool and resource for researchers conducting similar air pollution and health studies in India and other low- and middle-income countries (LMICs).
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Affiliation(s)
- Karthikeyan D Rajamani
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University);
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Naveen Puttaswamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Durairaj Natesan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Rengaraj Ramasamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Saritha Sendhil
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Amudha Natarajan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Vigneswari Aravindalochan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, University of California, Berkeley
| | | | - Joshua Rosenthal
- Division of International Epidemiology and Population Studies, National Institutes of Health
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | | | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University
| | - Bonnie Young
- Department of Environmental and Radiological Health Sciences, Colorado State University
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Informatics, Rollins School of Public Health, Emory University
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Miles Kirby
- Department of Global Health & Population, Harvard, T.H. Chan School of Public Health
| | - Lindsay J Underhill
- Cardiovascular Division, Washington University School of Medicine, Washington University
| | | | - Amy Lovvorn
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University)
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11
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Clasen TF, Chang HH, Thompson LM, Kirby MA, Balakrishnan K, Díaz-Artiga A, McCracken JP, Rosa G, Steenland K, Younger A, Aravindalochanan V, Barr DB, Castañaza A, Chen Y, Chiang M, Clark ML, Garg S, Hartinger S, Jabbarzadeh S, Johnson MA, Kim DY, Lovvorn AE, McCollum ED, Monroy L, Moulton LH, Mukeshimana A, Mukhopadhyay K, Naeher LP, Ndagijimana F, Papageorghiou A, Piedrahita R, Pillarisetti A, Puttaswamy N, Quinn A, Ramakrishnan U, Sambandam S, Sinharoy SS, Thangavel G, Underhill LJ, Waller LA, Wang J, Williams KN, Rosenthal JP, Checkley W, Peel JL. Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight. N Engl J Med 2022; 387:1735-1746. [PMID: 36214599 PMCID: PMC9710426 DOI: 10.1056/nejmoa2206734] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Exposure during pregnancy to household air pollution caused by the burning of solid biomass fuel is associated with adverse health outcomes, including low birth weight. Whether the replacement of a biomass cookstove with a liquefied petroleum gas (LPG) cookstove would result in an increase in birth weight is unclear. METHODS We performed a randomized, controlled trial involving pregnant women (18 to <35 years of age and at 9 to <20 weeks' gestation as confirmed on ultrasonography) in Guatemala, India, Peru, and Rwanda. The women were assigned in a 1:1 ratio to use a free LPG cookstove and fuel (intervention group) or to continue using a biomass cookstove (control group). Birth weight, one of four prespecified primary outcomes, was the primary outcome for this report; data for the other three outcomes are not yet available. Birth weight was measured within 24 hours after birth. In addition, 24-hour personal exposures to fine particulate matter (particles with a diameter of ≤2.5 μm [PM2.5]), black carbon, and carbon monoxide were measured at baseline and twice during pregnancy. RESULTS A total of 3200 women underwent randomization; 1593 were assigned to the intervention group, and 1607 to the control group. Uptake of the intervention was nearly complete, with traditional biomass cookstoves being used at a median rate of less than 1 day per month. After randomization, the median 24-hour personal exposure to fine particulate matter was 23.9 μg per cubic meter in the intervention group and 70.7 μg per cubic meter in the control group. Among 3061 live births, a valid birth weight was available for 94.9% of the infants born to women in the intervention group and for 92.7% of infants born to those in the control group. The mean (±SD) birth weight was 2921±474.3 g in the intervention group and 2898±467.9 g in the control group, for an adjusted mean difference of 19.6 g (95% confidence interval, -10.1 to 49.2). CONCLUSIONS The birth weight of infants did not differ significantly between those born to women who used LPG cookstoves and those born to women who used biomass cookstoves. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.).
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Affiliation(s)
- Thomas F Clasen
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Howard H Chang
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Lisa M Thompson
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Miles A Kirby
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Kalpana Balakrishnan
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Anaité Díaz-Artiga
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - John P McCracken
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Ghislaine Rosa
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Kyle Steenland
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Ashley Younger
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Vigneswari Aravindalochanan
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Dana B Barr
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Adly Castañaza
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Yunyun Chen
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Marilú Chiang
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Maggie L Clark
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Sarada Garg
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Stella Hartinger
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Shirin Jabbarzadeh
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Michael A Johnson
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Dong-Yun Kim
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Amy E Lovvorn
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Eric D McCollum
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Libny Monroy
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Lawrence H Moulton
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Alexie Mukeshimana
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Krishnendu Mukhopadhyay
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Luke P Naeher
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Florien Ndagijimana
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Aris Papageorghiou
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Ricardo Piedrahita
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Ajay Pillarisetti
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Naveen Puttaswamy
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Ashlinn Quinn
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Usha Ramakrishnan
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Sankar Sambandam
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Sheela S Sinharoy
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Gurusamy Thangavel
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Lindsay J Underhill
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Lance A Waller
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Jiantong Wang
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Kendra N Williams
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Joshua P Rosenthal
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - William Checkley
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
| | - Jennifer L Peel
- From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.)
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12
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Johnson M, Pillarisetti A, Piedrahita R, Balakrishnan K, Peel JL, Steenland K, Underhill LJ, Rosa G, Kirby MA, Díaz-Artiga A, McCracken J, Clark ML, Waller L, Chang HH, Wang J, Dusabimana E, Ndagijimana F, Sambandam S, Mukhopadhyay K, Kearns KA, Campbell D, Kremer J, Rosenthal JP, Checkley W, Clasen T, Naeher L. Exposure Contrasts of Pregnant Women during the Household Air Pollution Intervention Network Randomized Controlled Trial. Environ Health Perspect 2022; 130:97005. [PMID: 36112539 PMCID: PMC9480977 DOI: 10.1289/ehp10295] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Exposure to PM 2.5 arising from solid fuel combustion is estimated to result in ∼ 2.3 million premature deaths and 91 million lost disability-adjusted life years annually. Interventions attempting to mitigate this burden have had limited success in reducing exposures to levels thought to provide substantive health benefits. OBJECTIVES This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial. METHODS The HAPIN trial included 3,195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. Twenty-four-hour exposures to PM 2.5 , carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (n = 1,605 ) and LPG (n = 1,590 ) arms and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels. RESULTS Median postrandomization exposures of particulate matter (PM) with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) in the intervention arm were lower by 66% at the first (71.5 vs. 24.1 μ g / m 3 ), and second follow-up visits (69.5 vs. 23.7 μ g / m 3 ) compared to controls. BC exposures were lower in the intervention arm by 72% (9.7 vs. 2.7 μ g / m 3 ) and 70% (9.6 vs. 2.8 μ g / m 3 ) at the first and second follow-up visits, respectively, and carbon monoxide exposure was 82% lower at both visits (1.1 vs. 0.2 ppm ) in comparison with controls. Exposure reductions were consistent over time and were similar across research locations. DISCUSSION Postintervention PM 2.5 exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of PM 2.5 samples falling below the World Health Organization Annual Interim Target 1 of 35 μ g / m 3 . This study indicates that an LPG intervention can reduce PM 2.5 exposures to levels at or below WHO targets. https://doi.org/10.1289/EHP10295.
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Affiliation(s)
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | | | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay J. Underhill
- Cardiovascular Division, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miles A. Kirby
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - John McCracken
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lance Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Howard H. Chang
- 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
| | | | | | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Katherine A. Kearns
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Devan Campbell
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Jacob Kremer
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Luke Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - and the Household Air Pollution Intervention Network (HAPIN) Trial Investigators
- Berkeley Air Monitoring Group, Berkeley, California, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Cardiovascular Division, School of Medicine, Washington University, St. Louis, Missouri, USA
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Eagle Research Center, Kigali, Rwanda
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Checkley W, Hossen S, Rosa G, Thompson LM, McCracken JP, Diaz-Artiga A, Balakrishnan K, Simkovich SM, Underhill LJ, Nicolaou L, Hartinger SM, Davila-Roman VG, Kirby MA, Clasen TF, Rosenthal J, Peel JL. Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial. Int J Environ Res Public Health 2022; 19:3790. [PMID: 35409475 PMCID: PMC8997769 DOI: 10.3390/ijerph19073790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
Objective: Household Air Pollution Intervention Network (HAPIN) investigators tested a complex, non-pharmacological intervention in four low- and middle-income countries as a strategy to mitigate household air pollution and improve health outcomes across the lifespan. Intervention households received a liquefied petroleum gas (LPG) stove, continuous fuel delivery and regular behavioral reinforcements for 18 months, whereas controls were asked to continue with usual cooking practices. While HAPIN was designed as an explanatory trial to test the efficacy of the intervention on four primary outcomes, it introduced several pragmatic aspects in its design and conduct that resemble real-life conditions. We surveyed HAPIN investigators and asked them to rank what aspects of the design and conduct they considered were more pragmatic than explanatory. Methods: We used the revised Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) to survey investigators on the degree of pragmatism in nine domains of trial design and conduct using a five-point Likert rank scale from very explanatory (1) to very pragmatic (5). We invited 103 investigators. Participants were given educational material on PRECIS-2, including presentations, papers and examples that described the use and implementation of PRECIS-2. Results: Thirty-five investigators (mean age 42 years, 51% female) participated in the survey. Overall, only 17% ranked all domains as very explanatory, with an average (±SD) rank of 3.2 ± 1.4 across domains. Fewer than 20% of investigators ranked eligibility, recruitment or setting as very explanatory. In contrast, ≥50% of investigators ranked the trial organization, delivery and adherence of the intervention and follow-up as very/rather explanatory whereas ≤17% ranked them as rather/very pragmatic. Finally, <25% of investigators ranked the relevance of outcomes to participants and analysis as very/rather explanatory whereas ≥50% ranked then as rather/very pragmatic. In-country partners were more likely to rank domains as pragmatic when compared to investigators working in central coordination (average rank 3.2 vs. 2.8, respectively; Wilcoxon rank-sum p < 0.001). Conclusion: HAPIN investigators did not consider their efficacy trial to be rather/very explanatory and reported that some aspects of the design and conduct were executed under real-world conditions; however, they also did not consider the trial to be overly pragmatic. Our analysis underscores the importance of using standardized tools such as PRECIS-2 to guide early discussions among investigators in the design of environmental health trials attempting to measure efficacy.
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London WC1E 7HT, UK;
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30332, USA;
| | - John P. McCracken
- Epidemiology and Biostatistics Department, University of Georgia, Athens, GA 30606, USA;
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai 600116, India;
| | - Suzanne M. Simkovich
- Division of Healthcare Delivery Research, Medstar Health Research Institute, Hyattsville, MD 20782, USA;
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington, DC 20007, USA
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Stella M. Hartinger
- Latin American Center of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Joshua Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA;
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14
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Simkovich SM, Underhill LJ, Kirby MA, Crocker ME, Goodman D, McCracken JP, Thompson LM, Diaz-Artiga A, Castañaza-Gonzalez A, Garg SS, Balakrishnan K, Thangavel G, Rosa G, Peel JL, Clasen TF, McCollum ED, Checkley W. Resources and Geographic Access to Care for Severe Pediatric Pneumonia in Four Resource-limited Settings. Am J Respir Crit Care Med 2022; 205:183-197. [PMID: 34662531 PMCID: PMC8787246 DOI: 10.1164/rccm.202104-1013oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
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Affiliation(s)
- Suzanne M. Simkovich
- Division of Pulmonary and Critical Care
- Center for Global Non-Communicable Disease Research and Training, and
- Medstar Health Research Institute, Hyattsville, Maryland
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical Care
- Center for Global Non-Communicable Disease Research and Training, and
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Mary E. Crocker
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital and School of Medicine, University of Washington, Seattle, Washington
| | - Dina Goodman
- Division of Pulmonary and Critical Care
- Center for Global Non-Communicable Disease Research and Training, and
| | - John P. McCracken
- Global Health Institute, Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | | | - Anaité Diaz-Artiga
- Centro de Estudios de la Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Adly Castañaza-Gonzalez
- Centro de Estudios de la Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Sarada S. Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute (Deemed University), Chennai, Tamil Nadu, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute (Deemed University), Chennai, Tamil Nadu, India
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College and Research Institute (Deemed University), Chennai, Tamil Nadu, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences and
- Global Program for Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William Checkley
- Division of Pulmonary and Critical Care
- Center for Global Non-Communicable Disease Research and Training, and
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Siddharthan T, Robertson NM, Rykiel NA, Underhill LJ, Rahman N, Kafle S, Mohan S, Padalkar R, McKeown S, Flores-Flores O, Quaderi SA, Alupo P, Kalyesubula R, Kirenga B, Luo J, Cárdenas MK, Gianella G, Miranda JJ, Checkley W, Hurst JR, Pollard SL. Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings. PLOS Glob Public Health 2022; 2:e0001309. [PMID: 36962898 PMCID: PMC10021856 DOI: 10.1371/journal.pgph.0001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). METHODS All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD. RESULTS We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. CONCLUSION The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.
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Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, Miami, Florida, United States of America
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nicole M Robertson
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- University of Kentucky School of Medicine, Louisville, Kentucky, United States of America
| | - Natalie A Rykiel
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lindsay J Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nihaal Rahman
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sujan Kafle
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Roma Padalkar
- Rowan University School of Osteopathic Medicine, Glassboro, New Jersey, United States of America
| | - Sarah McKeown
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Oscar Flores-Flores
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
| | | | - Patricia Alupo
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Jing Luo
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gonzalo Gianella
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - John R Hurst
- Respiratory Medicine, University College London, London, United Kingdom
| | - Suzanne L Pollard
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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16
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Simkovich SM, Thompson LM, Clark ML, Balakrishnan K, Bussalleu A, Checkley W, Clasen T, Davila-Roman VG, Diaz-Artiga A, Dusabimana E, Fuentes LDL, Harvey S, Kirby MA, Lovvorn A, McCollum ED, Mollinedo EE, Peel JL, Quinn A, Rosa G, Underhill LJ, Williams KN, Young BN, Rosenthal J. A risk assessment tool for resumption of research activities during the COVID-19 pandemic for field trials in low resource settings. BMC Med Res Methodol 2021; 21:68. [PMID: 33845785 PMCID: PMC8040756 DOI: 10.1186/s12874-021-01232-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
RATIONALE The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. OBJECTIVES In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial conducted in rural, low-resource settings, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize the integrity of reseach aims while minimizing infection risk based on the latest scientific understanding of the virus. METHODS We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. National and local government recommendations provided the minimum safety guidelines for our work. RESULTS Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential viral aerosolization while performing the activity. For each activity, one of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities that can potentially aerosolize the virus are deemed the highest risk. CONCLUSIONS By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we were able to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our staff, participants, local communities, and funders. This framework can be tailored to other research studies conducted in similar settings during the current pandemic, as well as potential future outbreaks with similar transmission dynamics. The trial is registered with clinicaltrials.gov NCT02944682 on October 26. 2016 .
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Affiliation(s)
- Suzanne M Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA.
- MedStar Health Research Institute, Hyattsville, USA.
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Alejandra Bussalleu
- A.B. PRISMA, San Miguel, Peru
- CLIMA - Latin American Center of Excellence in Climate Change and Health; and Intercultural Citizenship and Indigenous Health Unit, Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - 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, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, USA
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, USA
| | - Steven Harvey
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Miles A Kirby
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amy Lovvorn
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Eric D McCollum
- Global Program for Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Erick E Mollinedo
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - Ashlinn Quinn
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsay J Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Kendra N Williams
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Bonnie N Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - Joshua Rosenthal
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA
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17
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Tieskens KF, Milando CW, Underhill LJ, Vermeer K, Levy JI, Fabian MP. The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach. Environ Health 2021; 20:14. [PMID: 33583411 PMCID: PMC7883428 DOI: 10.1186/s12940-021-00699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities. METHODS We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA. RESULTS Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost. CONCLUSION The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.
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Affiliation(s)
- Koen F. Tieskens
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Chad W. Milando
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Lindsay J. Underhill
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Kimberly Vermeer
- Urban Habitat Initiatives Inc, 328A Tremont Street, Boston, MA 02116 USA
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
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18
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Underhill LJ, Dols WS, Lee SK, Fabian MP, Levy JI. Quantifying the impact of housing interventions on indoor air quality and energy consumption using coupled simulation models. J Expo Sci Environ Epidemiol 2020; 30:436-447. [PMID: 31959901 PMCID: PMC7325860 DOI: 10.1038/s41370-019-0197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/17/2019] [Accepted: 10/04/2019] [Indexed: 05/16/2023]
Abstract
While residential energy and ventilation standards aim to improve the energy performance and indoor air quality (IAQ) of homes, their combined impact across diverse residential activities and housing environments has not been well-established. This study demonstrates the insights that a recently-developed, freely-available coupled IAQ-energy modeling platform can provide regarding the energy and IAQ trade-offs of weatherization (i.e., sealing and insulation) and ventilation retrofits in multifamily housing across varied indoor occupant activity and mechanical ventilation scenarios in Boston, MA. Overall, it was found that combined weatherization and improved ventilation recommended by design standards could lead to both energy savings and IAQ-related benefits; however, ventilation standards may not be sufficient to protect against IAQ disbenefits for residents exposed to strong indoor sources (e.g., heavy cooking or smoking) and could lead to net increases in energy costs (e.g., due to the addition of continuous outdoor air ventilation). The modeling platform employed in this study is flexible and can be applied to a wide range of building typologies, retrofits, climates, and indoor occupant activities; therefore, it stands as a valuable tool for identifying cost-effective interventions that meet both energy efficiency and ventilation standards and improve IAQ across diverse housing populations.
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Affiliation(s)
- Lindsay J Underhill
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - W Stuart Dols
- Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD, 20899, USA
| | - Sharon K Lee
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
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19
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Burrowes VJ, Piedrahita R, Pillarisetti A, Underhill LJ, Fandiño‐Del‐Rio M, Johnson M, Kephart JL, Hartinger SM, Steenland K, Naeher L, Kearns K, Peel JL, Clark ML, Checkley W. Comparison of next-generation portable pollution monitors to measure exposure to PM 2.5 from household air pollution in Puno, Peru. Indoor Air 2020; 30:445-458. [PMID: 31885107 PMCID: PMC7217081 DOI: 10.1111/ina.12638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 05/05/2023]
Abstract
Assessment of personal exposure to PM2.5 is critical for understanding intervention effectiveness and exposure-response relationships in household air pollution studies. In this pilot study, we compared PM2.5 concentrations obtained from two next-generation personal exposure monitors (the Enhanced Children MicroPEM or ECM; and the Ultrasonic Personal Air Sampler or UPAS) to those obtained with a traditional Triplex Cyclone and SKC Air Pump (a gravimetric cyclone/pump sampler). We co-located cyclone/pumps with an ECM and UPAS to obtain 24-hour kitchen concentrations and personal exposure measurements. We measured Spearmen correlations and evaluated agreement using the Bland-Altman method. We obtained 215 filters from 72 ECM and 71 UPAS co-locations. Overall, the ECM and the UPAS had similar correlation (ECM ρ = 0.91 vs UPAS ρ = 0.88) and agreement (ECM mean difference of 121.7 µg/m3 vs UPAS mean difference of 93.9 µg/m3 ) with overlapping confidence intervals when compared against the cyclone/pump. When adjusted for the limit of detection, agreement between the devices and the cyclone/pump was also similar for all samples (ECM mean difference of 68.8 µg/m3 vs UPAS mean difference of 65.4 µg/m3 ) and personal exposure samples (ECM mean difference of -3.8 µg/m3 vs UPAS mean difference of -12.9 µg/m3 ). Both the ECM and UPAS produced comparable measurements when compared against a cyclone/pump setup.
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Affiliation(s)
- Vanessa J. Burrowes
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Ajay Pillarisetti
- Environmental Health SciencesUniversity of California BerkeleyBerkeleyCAUSA
- Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Magdalena Fandiño‐Del‐Rio
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Josiah L. Kephart
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Stella M. Hartinger
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Facultad de Salud Pública y AdministraciónUniversidad Peruana Cayetano HerediaLimaPeru
- Swiss Tropical and Public Health InstituteBaselSwitzerland
| | - Kyle Steenland
- Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Luke Naeher
- Department of Environmental Health SciencesUniversity of Georgia College of Public HealthAthensGAUSA
| | - Katie Kearns
- Department of Environmental Health SciencesUniversity of Georgia College of Public HealthAthensGAUSA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health SciencesColorado State UniversityCOUSA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health SciencesColorado State UniversityCOUSA
| | - William Checkley
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
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20
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Johnson MA, Steenland K, Piedrahita R, Clark ML, Pillarisetti A, Balakrishnan K, Peel JL, Naeher LP, Liao J, Wilson D, Sarnat J, Underhill LJ, Burrowes V, McCracken JP, Rosa G, Rosenthal J, Sambandam S, de Leon O, Kirby MA, Kearns K, Checkley W, Clasen T. Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial. Environ Health Perspect 2020; 128:47009. [PMID: 32347764 PMCID: PMC7228125 DOI: 10.1289/ehp6422] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru. OBJECTIVES The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures. METHODS Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM < 2.5 μ m in aerodynamic diameter (PM 2.5 )] with the Enhanced Children's MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children < 1 year of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of PM 2.5 exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur. CONCLUSIONS The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. https://doi.org/10.1289/EHP6422.
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Affiliation(s)
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Jiawen Liao
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Jeremy Sarnat
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay J Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Burrowes
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Oscar de Leon
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Miles A Kirby
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Katherine Kearns
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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21
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Simkovich SM, Underhill LJ, Kirby MA, Goodman D, Crocker ME, Hossen S, McCracken JP, de León O, Thompson LM, Garg SS, Balakrishnan K, Thangavel G, Rosa G, Peel JL, Clasen TF, McCollum ED, Checkley W. Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial. ERJ Open Res 2020; 6:00308-2019. [PMID: 32211438 PMCID: PMC7086071 DOI: 10.1183/23120541.00308-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.
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Affiliation(s)
- Suzanne M. Simkovich
- 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
| | - Lindsay J. Underhill
- 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
| | - Miles A. Kirby
- Dept of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dina Goodman
- 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
| | - Mary E. Crocker
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - 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
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Oscar de León
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Lisa M. Thompson
- Dept of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Sarada S. Garg
- Dept of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India
| | - Kalpana Balakrishnan
- Dept of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India
| | - Gurusamy Thangavel
- Dept of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer L. Peel
- Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Thomas F. Clasen
- Dept of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Dept of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Global Program on Pediatric Respiratory Sciences, Dept of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- These authors contributed equally
| | - 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
- These authors contributed equally
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22
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Underhill LJ, Bose S, Williams DL, Romero KM, Malpartida G, Breysse PN, Klasen EM, Combe JM, Checkley W, Hansel NN. Association of Roadway Proximity with Indoor Air Pollution in a Peri-Urban Community in Lima, Peru. Int J Environ Res Public Health 2015; 12:13466-81. [PMID: 26516875 PMCID: PMC4627043 DOI: 10.3390/ijerph121013466] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/26/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022]
Abstract
The influence of traffic-related air pollution on indoor residential exposure is not well characterized in homes with high natural ventilation in low-income countries. Additionally, domestic allergen exposure is unknown in such populations. We conducted a pilot study of 25 homes in peri-urban Lima, Peru to estimate the effects of roadway proximity and season on residential concentrations. Indoor and outdoor concentrations of particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) were measured during two seasons, and allergens were measured in bedroom dust. Allergen levels were highest for dust mite and mouse allergens, with concentrations above clinically relevant thresholds in over a quarter and half of all homes, respectively. Mean indoor and outdoor pollutant concentrations were similar (PM2.5: 20.0 vs. 16.9 μg/m3, BC: 7.6 vs. 8.1 μg/m3, NO2: 7.3 vs. 7.5 ppb), and tended to be higher in the summer compared to the winter. Road proximity was significantly correlated with overall concentrations of outdoor PM2.5 (rs = −0.42, p = 0.01) and NO2 (rs = −0.36, p = 0.03), and outdoor BC concentrations in the winter (rs = −0.51, p = 0.03). Our results suggest that outdoor-sourced pollutants significantly influence indoor air quality in peri-urban Peruvian communities, and homes closer to roadways are particularly vulnerable.
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Affiliation(s)
- Lindsay J Underhill
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Sonali Bose
- Division of Pulmonary and Critical Care, School of Medicine, John Hopkins University, Baltimore, MD 21224, USA.
| | - D'Ann L Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | | | - Gary Malpartida
- Laboratorio de Investigacion y Desarrollo, Universidad Peruana Cayetano Heredia, Lima 31, Peru.
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Elizabeth M Klasen
- Division of Pulmonary and Critical Care, School of Medicine, John Hopkins University, Baltimore, MD 21224, USA.
| | - Juan M Combe
- Center for Asthma Research, A.B. PRISMA, Lima 32, Peru.
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, John Hopkins University, Baltimore, MD 21224, USA.
- Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care, School of Medicine, John Hopkins University, Baltimore, MD 21224, USA.
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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23
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Lovasi GS, Underhill LJ, Jack D, Richards C, Weiss C, Rundle A. At Odds: Concerns Raised by Using Odds Ratios for Continuous or Common Dichotomous Outcomes in Research on Physical Activity and Obesity. ACTA ACUST UNITED AC 2012; 5:13-17. [PMID: 23002407 DOI: 10.2174/1874297101205010013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: Research on obesity and the built environment has often featured logistic regression and the corresponding parameter, the odds ratio. Use of odds ratios for common outcomes such obesity may unnecessarily hinder the validity, interpretation, and communication of research findings. METHODS: We identified three key issues raised by the use of odds ratios, illustrating them with data on walkability and body mass index from a study of 13,102 New York City residents. RESULTS: First, dichotomization of continuous measures such as body mass index discards theoretically relevant information, reduces statistical power, and amplifies measurement error. Second, odds ratios are systematically higher (further from the null) than prevalence ratios; this inflation is trivial for rare outcomes, but substantial for common outcomes like obesity. Third, odds ratios can lead to incorrect conclusions during tests of interactions. The odds ratio in a particular subgroup might higher simply because the outcome is more common (and the odds ratio inflated) compared with other subgroups. CONCLUSION: Our recommendations are to take full advantage of continuous outcome data when feasible and to use prevalence ratios in place of odds ratios for common dichotomous outcomes. When odds ratios must be used, authors should document outcome prevalence across exposure groups.
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Affiliation(s)
- Gina S Lovasi
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, Room 804, New York, NY 10032, USA
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