Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon

INTRODUCTION

Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population.

METHODS

This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors.

RESULTS

From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations.

CONCLUSION

Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.

Associations of Caregiver Cooking Skills with Child Dietary Behaviors and Weight Status: Results from the A-CHILD Study

We examined whether caregiver cooking skills were associated with frequency of home cooking, child dietary behaviors, and child body weight status in Japan. We used cross-sectional data from the 2018 Adachi Child Health Impact of Living Difficulty study, targeting primary and junior high school students aged 9-14 years in Adachi City, Tokyo, Japan (n = 5257). Caregiver cooking skills were assessed using a scale with good validity and reliability modified for use in Japan. Child heights and weights derived from school heath checkup data were used to calculate WHO standard body mass index z-scores. After adjusting for potential confounders, caregivers with low-level cooking skills were 4.31 (95% confidence interval (CI): 2.68-6.94) times more likely to have lower frequency of home cooking than those with high level of cooking skills. Children with low-level caregiver cooking skills were 2.81 (95% CI: 2.06-3.84) times more likely to have lower frequency of vegetable intake and 1.74 (95% CI: 1.08-2.82) times more likely to be obese. A low level of caregiver cooking skills was associated with infrequent home cooking, unhealthy child dietary behaviors, and child obesity.

Solid cooking fuel use and cognitive decline among older Mexican adults

Studies of air pollution and cognition often rely on measures from outdoor environments. Many individuals in low- and middle-income countries are exposed to indoor air pollution from combustion of solid cooking fuels. Little is known about how solid cooking fuel use affects cognitive decline over time. This study uses data from the 2012, 2015, and 2018 Mexican Health and Aging Study (n = 14 245, age 50+) to assess how use of wood or coal for cooking fuel affects cognition of older adults relative to use of gas. It uses latent change score modeling to determine how using solid cooking fuel affected performance in Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency. Solid cooking fuel was used by 17% of the full sample but was more common in rural areas. Solid fuel users also had lower socioeconomic status. Compared to those using gas, solid fuel users had lower baseline scores and faster decline in Verbal Learning (β = -0.18, p < 0.05), Visual Scanning (β = -1.00, p < 0.001), and Verbal Fluency (β = -0.33, p < 0.001). Indoor air pollution from solid cooking fuels may represent a modifiable risk factor for cognitive decline. Policy should focus on facilitating access to clean cooking fuels.

Association of Funding and Meal Preparation Time With Nutritional Quality of Meals of Supplemental Nutritional Assistance Program Recipients

IMPORTANCE

The Supplemental Nutrition Assistance Program (SNAP) is a federal program that provides food-purchasing assistance to low-income people; however, its current design does not account for the time availability of SNAP recipients to prepare meals.

OBJECTIVE

To evaluate the association of the availability of funding for food purchases and time for meal preparation with the nutritional quality of meals of SNAP recipients.

DESIGN, SETTING, AND PARTICIPANTS

This study used decision analytical modeling to evaluate the nutritional quality of meals of SNAP recipients. The model was developed from February 6, 2017, to December 12, 2020, using data from 2017 and is based on discrete optimization. The model describes food and grocery purchasing, in-home meal preparation, and meal plan choices of a family of SNAP participants (2 adults and 2 children) while considering food preferences, meal preparation time, and food costs. The model assumes food preferences match the foods typically purchased by SNAP households. Costs of food ingredients and prepared foods are taken from a single zip code.

EXPOSURES

Time availability and total amount and type of funding were varied. Allowing prepared delicatessen foods and disallowing frozen prepared foods for purchase using SNAP funds were considered.

MAIN OUTCOMES AND MEASURES

The primary outcome was the number of home-cooked meals and the amounts of fruits, vegetables, protein, sodium, sugar, and fiber consumed from generated meal plans. Amounts were evaluated as a percentage of the quantity recommended by established dietary guidelines.

RESULTS

Increased time availability was associated with increases in the percentage of home-cooked meals and servings of fruits/vegetables and decreased sodium consumption. Higher levels of funding were associated with increased consumption of fiber, fruits/vegetables, protein, sodium, and sugar. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 20.1% (0.3%) of meals home cooked, 0.5 (<0.1) servings/d per person of fruits/vegetables, 100.3% (0.6%) of daily recommended protein per person, 115.1% (0.8%) of daily recommended sodium per person, 241.8% (1.0%) of daily recommended sugar per person, and 31.2% (0.3%) of daily recommended fiber per person. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 23.9% (1.0%) of meals home cooked, 2.8 (0.1) servings/d per person of fruits/vegetables, 134.9% (1.6%) of daily recommended protein per person, 200.9% (3.1%) of daily recommended sodium per person, 295.1% (3.1%) of daily recommended sugar per person, and 90.1% (1.0%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 52.7% (0.9%) of meals home cooked, 1.4 (<0.1) servings/d per person of fruits/vegetables, 109.0% (1.1%) of daily recommended protein per person, 108.7% (1.0%) of daily recommended sodium per person, 298.6% (2.0%) of daily recommended sugar per person, and 38.8% (0.4%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 42.8% (1.2%) meals home cooked, 4.3 (0.1) servings/d per person of fruits/vegetables, 144.4% (1.8%) of daily recommended protein per person, 165.2% (2.8%) of daily recommended sodium per person, 322.4% (2.4%) of daily recommended sugar per person, and 91.0% (0.9%) of daily recommended fiber per person.

CONCLUSIONS AND RELEVANCE

In this decision analytical model, meal preparation time was associated with the ability of SNAP recipient families to consume nutritious meals, suggesting that increased funding alone may be insufficient for improving the nutritional profiles of SNAP recipients. Given the current US food supply, governmental interventions that provide the equivalence in increased time availability to achieve nutritious meals may be needed.

CooC11 and CooC7: the development and validation of age appropriate children's perceived cooking competence measures

BACKGROUND

Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes including cooking confidence in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children.

METHODS

Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8-12 years) and younger (6-7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson's Correlations, ANOVAs and Cronbach's Alphas.

RESULTS

Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach's Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P< 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P< 0.01).

CONCLUSIONS

The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children's perceived Cooking Competence for ages 8-12 and 6-7 years respectively. They can be used to evaluate the efficacy of children's cooking intervention studies or school nutrition education programmes.

Cooking, smoking, and stunting: Effects of household air pollution sources on childhood growth in India

This paper investigates the effects of household air pollution (HAP) on child stunting in India using a sample of 206, 898 under-five children from the latest National Family Health Survey (2015-16). Descriptive statistics and multivariate analysis were used to understand the association of stunting by type of cooking fuel, separate kitchen, and indoor smoking in the household. Using clean cooking fuels (CCFs), having a separate kitchen, and being unexposed to smoking can reduce the prevalence of stunting by 4%, 1%, and 1%, respectively, from the current prevalence of stunting (38%). The probability of childhood stunting among children living in households using unclean cooking fuel (UCF) was significantly higher (OR-1.16; 95% CI: 1.13-1.19) than those living in households using CCF. Findings were similar results in the absence of separate kitchen (OR-1.08; 95% CI: 1.05-1.10) and exposure to environmental tobacco smoke (OR-1.06; 95% CI: 1.04-1.08). Households using UCF had a 16% higher likelihood of stunting, while there was a strong gradient of HAP with stunting after controlling socioeconomic and demographic factors. Therefore, the LPG programs, such as the Pradhan Mantri Ujjwala Yojana, may be crucial to reduce HAP and its adverse impact on stunting, and successively to achieve sustainable development goals.

Home Cooking Is Related to Potential Reduction in Cardiovascular Disease Risk among Adolescents: Results from the A-CHILD Study

This study aimed to investigate the association between the frequency of home cooking and cardiovascular disease risk among Japanese adolescents. We used cross-sectional data on adolescents from the 2018 Adachi Child Health Impact of Living Difficulty study, which targeted junior high school students aged 13–14 years in Adachi, Tokyo, Japan. Frequency of home cooking by 553 caregivers was assessed via questionnaire and classified as high (almost daily), medium (4–5 days/week), or low (≤3 days/week). Cardiovascular disease risk factors included blood pressure, serum cholesterol (total, LDL, and HDL), hemoglobin A1c, and body mass index. Multiple linear regression analysis revealed that adolescents exposed to a low frequency of home cooking showed higher diastolic blood pressure (β = 3.59, 95% confidence interval [CI]: 0.42 to 6.75) and lower HDL cholesterol (β = −6.15, 95% CI: −11.2 to −1.07) than those exposed to a high frequency of home cooking, adjusting for adolescents’ sex, household income, and parental comorbidity. Future studies are needed to clarify the causal relationship and mechanisms through which home cooking influences adolescents’ cardiovascular health.

Food Skills and Their Relationship with Food Security and Dietary Diversity Among Asylum Seekers Living in Norway

OBJECTIVE

To investigate the impact of food skills on food security and dietary diversity among asylum seekers living in Norwegian reception centers.

DESIGN

Cross-sectional study.

SETTING

Eight asylum reception centers.

PARTICIPANTS

A total of 205 asylum seekers (131 men and 74 women) recruited through convenience sampling.

MAIN OUTCOME MEASURES

Food skills were measured using questions from the Canadian Rapid Response on Food Skills and divided into cooking skills and shopping skills. Food security was measured with the 10-item version of the Radimer/Cornell Scale. The dietary diversity score was based on a 24-h recall.

ANALYSIS

Bivariate and multivariable logistic regression.

RESULTS

Cooking skills were associated with adequate dietary diversity (adjusted odds ratio, 2.12; 95% confidence interval, 1.04-4.31), but not with adult food insecurity (adjusted odds ratio. 0.63; 95% confidence interval, 0.26-1.53). Shopping skills were not associated with either measure of dietary diversity or adult food insecurity. Women had higher cooking skills than men, but there were no gender differences in shopping skills.

CONCLUSIONS AND IMPLICATIONS

Food skills had a limited association with food security and dietary diversity. Further research is needed to identify food skills beneficial for asylum seekers and to address the multiple causes of food insecurity.

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis

Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.

Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study

BACKGROUND

Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments.

METHODS

As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period.

FINDINGS

Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43-48]), electricity (53 μg/m3 [47-60]), coal (68 μg/m3 [61-77]), charcoal (92 μg/m3 [58-146]), agricultural or crop waste (106 μg/m3 [91-125]), wood (109 μg/m3 [102-118]), animal dung (224 μg/m3 [197-254]), and shrubs or grass (276 μg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women).

INTERPRETATION

Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies.

FUNDING

Canadian Institutes for Health Research, National Institutes of Health.

Mustard oil consumption, cooking method, diet and gallbladder cancer risk in high- and low-risk regions of India

The current study aimed to investigate the role of cooking with mustard oil and other dietary factors in relation to gallbladder cancer (GBC) in high- and low-incidence regions of India. A case-control study was conducted including 1,170 histologically confirmed cases and 2,525 group-matched visitor controls from the largest cancer hospital in India. Dietary data were collected through a food frequency questionnaire. For oil consumption, we enquired about monthly consumption of 11 different types of cooking oil per family and the number of individuals usually sharing the meal to estimate per-individual consumption of oil. Information about method of cooking was also requested. Odds ratios (ORs) and 95% confidence intervals (CIs) quantifying the association of GBC risk consumption of different types of oil, method of cooking, and dietary food items, were estimated using logistic regression models, after adjusting for potential confounders. High consumption of mustard oil was associated with GBC risk in both high- and low-risk regions (OR = 1.33, 95% CI = 0.99-1.78; OR = 3.01, 95% CI = 1.66-5.45), respectively. An increased risk of GBC was observed with deep frying of fresh fish in mustard oil (OR = 1.57, 95% CI = 0.99-2.47, p-value = 0.052). A protective association was observed with consumption of leafy vegetables, fruits, onion and garlic. No association was observed between consumption of meat, spicy food, turmeric, pulses or with any other oil as a cooking medium. The effect of high consumption of mustard oil on GBC risk, if confirmed, has implications for the primary prevention of GBC, via a reduced consumption.

Acquisition of Cooking Skills and Associations With Healthy Eating in Swiss Adults

OBJECTIVE

To evaluate the association of early involvement in cooking activities with cooking skills in adulthood, the importance of different sources for the acquisition, and the link between cooking skills and healthy eating.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A random sample of 3,659 Swiss adults (47% men; average age = 58.8 years).

MAIN OUTCOME MEASURE

Self-reported cooking skills.

ANALYSIS

ANOVA, Pearson correlations, t tests, and multiple regressions.

RESULTS

More frequent involvement in cooking activities during childhood predicted better cooking skills in adulthood in males (β = .13, P < .001) and females (β = .12, P < .001). Females were more involved than males in most age groups (P < .001). Women learned most about cooking from their mothers, cooking courses, and self-study using different media. Men identified their partners/spouses and mothers as the 2 most important sources. The study found associations between cooking skills and diet quality in men (r = .11; P < .001; r² = .01) and women (r = .12; P < .001; r² = .01).

CONCLUSIONS AND IMPLICATIONS

In children and adolescents, frequent involvement in cooking at home may promote better cooking skills in later life. Additional prospective research into the impact of cooking classes and interventions on developing cooking skills in children and adolescents is warranted.

Household cooking fuel use and its health effects among rural women in southern India-A cross-sectional study

The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79–8.29), respiratory (OR = 5.04; 95% CI: 2.52–10.07), cardiovascular (OR = 6.07; 95% CI: 1.88–19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07–12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08–5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.

Open fire ovens and effects of in-home lavash bread baking on carbon monoxide exposure and carboxyhemoglobin levels among women in rural Armenia

Lavash is a traditional flatbread commonly baked at home by women in Armenia and other Middle Eastern and Caucasus countries. The baking process follows centuries' old recipes and is done primarily in open fire ovens. Data are limited regarding the impact of baking on indoor air quality and health outcomes. This study aimed at assessing the effects of lavash baking on household air pollution and cardiovascular outcomes among women who bake lavash in rural Armenia. A convenience sample of 98 bakers, all women, never-smokers, representing 36 households were enrolled. Carbon monoxide (CO) concentrations and carboxyhemoglobin (COHb) levels were monitored before, during, and/or after baking. As expected, exposure to concentrations of CO peaking at/or above 35-ppm during baking was more likely to occur in homes with fully enclosed and poorly ventilated baking rooms, compared to those with three or fewer walls and/or one or more windows. Bakers in homes where CO concentrations peaked at/or above 35-ppm were more likely to have an increase in post-baking COHb levels compared to those in homes with lower CO concentrations.

Women exposure to household air pollution after an improved cookstove program in rural San Luis Potosi, Mexico

The state government of San Luis Potosí (SLP), Mexico implemented an improved cookstove (ICS) program in rural areas. As part of the comprehensive program evaluation, we compared fine particulate material (PM_2.5) concentrations in kitchens and patios in treated (TH), and non-treated households (NTH), and analyzed pollutant levels according to patterns of fuels and devices use reported by the women. A panel study was conducted in 728 households (357 TH and 371 NTH) in three regions of SLP including two sampling rounds in 2015-16. Data on exposure determinants, ICS conditions and cooking practices were collected. Daily PM_2.5 in kitchen and patio was measured in a subsample. The average treatment effect was estimated using the double difference method. We constructed a mixed linear model to estimate PM_2.5 levels for the entire study sample and obtained personal exposure according to time-activity logs. NTH had lower socioeconomic status compared to TH. The average daily PM_2.5 concentrations in NTH compared to TH were 155.2 and 92.6 μg/m³ for kitchen and 35.4 and 39.8 μg/m³ for patio, respectively. PM_2.5 levels showed significant regional differences but no significant treatment effect. In many cases, the ICS was added to previous open fire and LPG use (stacking). The household size, kitchen ventilation, relative humidity, temperature and the ratio of indoor/outdoor PM_2.5 concentration were significant predictors of kitchen PM_2.5 levels. The daily PM_2.5 personal exposure was significantly reduced using ICS in good conditions or LPG (57 μg/m³) compared to the traditional open fire (86 μg/m³). This study strengthens the evidence on the potential daily PM_2.5 exposure reduction for women using an ICS in good conditions or LPG, displacing the polluting open fire. Comprehensive strategies tailored to the sociocultural context of the communities are needed to implement clean energy programs that achieve adoption and sustained use of ICS or LPG.

Doneness preferences, meat and meat-derived heterocyclic amines intake, and N-acetyltransferase 2 polymorphisms: association with colorectal adenoma in Japanese Brazilians

Intake of heterocyclic amines (HCAs) and other mutagenic compounds formed during cooking has been hypothesized to be responsible for the positive association observed between red meat and colorectal cancer. We evaluated whether well-done/very well-done preferences for various meat and fish items, higher intakes of meat and fish, and meat-derived and fish-derived HCA are associated with the risk of colorectal adenoma (CRA) in a Japanese-Brazilian population. We selected 302 patients with adenoma and 403 control individuals who underwent total colonoscopy between 2007 and 2013, and collected information on aspects of meat intake using a detailed questionnaire. We also estimated HCA intake of the study participants using an HCA database that matched the cooking methods of this population. Latent class analysis on the basis of response to doneness preferences for different cooking methods of commonly consumed meat and fish items identified four distinct subgroups. Compared with the subgroup characterized by a preference for rare/medium well-done cooking for most meat and fish items, the odds ratio of CRA for the well-done/very well-done preference subgroup was 1.19 (95% confidence interval: 0.51-2.75). High intake of mixed-meat dishes was suggestively associated inversely with CRA, whereas a high intake of poultry was associated positively with CRA. No clear association with intake of total or specific HCAs and no effect modification by N-acetyltransferase 2 acetylation genotype were observed. We found no statistically significant associations between meat and HCA intake and CRA. These findings do not support a positive association between meat and meat-derived HCA intake and the risk of CRA.

C-reactive protein from dried blood spots: Application to household air pollution field studies

Household air pollution (HAP) is estimated to be an important risk factor for cardiovascular disease, but little clinical evidence exists and collecting biomarkers of disease risk is difficult in low-resource settings. Among 54 Nicaraguan women with woodburning cookstoves, we evaluated cross-sectional associations between 48-hour measures of HAP (eg, fine particulate matter, PM_2.5 ) and C-reactive protein (CRP) via dried blood spots; secondary analyses included seven additional biomarkers of systemic injury and inflammation. We conducted sub-studies to calculate the intraclass correlation coefficient (ICC) in biomarkers collected over four consecutive days in Nicaragua and to assess the validity of measuring biomarkers in dried blood by calculating the correlation with paired venous-drawn samples in Colorado. Measures of HAP were associated with CRP (eg, a 25% increase in indoor PM_2.5 was associated with a 7.4% increase in CRP [95% confidence interval: 0.7, 14.5]). Most of the variability in CRP concentrations over the 4-day period was between-person (ICC: 0.88), and CRP concentrations were highly correlated between paired dried blood and venous-drawn serum (Spearman ρ = .96). Results for secondary biomarkers were primarily consistent with null associations, and the sub-study ICCs and correlations were lower. Assessing CRP via dried blood spots provides a feasible approach to elucidate the association between HAP and cardiovascular disease risk.

Respiratory Symptoms and Lung Function among Ethiopian Women in Relation to Household Fuel Use

Exposure to household air pollution has been linked to chronic obstructive pulmonary disease, respiratory symptoms and reduced lung function. This study aims to assess respiratory symptoms and lung function among Ethiopian women in relation to exposure to HAP. We conducted a cross-sectional study among non-smoking women responsible for household cooking. Data was collected on socio-demographic characteristics, respiratory symptoms and risk factors using a validated questionnaire. Spirometry with reversibility testing was performed according to American Thoracic Society/European Respiratory Society guidelines. We used independent t-test and multivariable logistic regression to compare the means and measure association respectively. A total of 545 women participated in the study out of which 231 (42.3%) performed spirometry with at least three acceptable manoeuvres. Everyone in the rural group and 43% of the urban group were exposed to HAP from solid fuels during cooking. The odds of developing at least one respiratory symptom when compared with those using cleaner fuels are twice as high for women cooking within the living house. We also found significantly lower forced expiratory volume in the first second (FEV1) (L) among solid fuels users compared with cleaner energy users. Given the larger population settlement in the rural areas and the use of solid fuel as the only energy source, there is a higher risk of developing chronic respiratory health problems for those women in Ethiopia.

Community Culinary Workshops as a Nutrition Curriculum in a Preventive Medicine Residency Program

INTRODUCTION

Obesity and diabetes are common diagnoses in the primary care population, especially in urban settings. Physicians providing preventive culinary and nutrition education to patients may be able to uniquely address these medical issues; however, culinary and nutrition education among medical residency programs is insufficient.

METHODS

We describe a pilot of a novel interactive approach to culinary and nutrition education focused on preventive medicine residents who were trained to provide culinary and nutrition skills to community members in three separate workshops. We developed and implemented a series of three culinary education workshops with 11, eight, and nine preventive medicine residents in each respective workshop. A total of 16 residents were invited to participate. A physician-chef facilitated each workshop with the residents within a community church kitchen and meeting area. We evaluated self-reported data on confidence level with culinary education and resident attitudes toward effects of culinary education on patient behaviors, as well as frequency of home-cooked meals and personal cooking competency, as indicators of resident proficiency.

RESULTS

A significant increase was noted in self-reported cooking competency after culinary workshops when evaluating change from the first workshop to the final workshop ( p = .038). Increases in home-cooking frequency and belief that lifestyle medicine impacts patient behavior were also observed but did not achieve statistical significance.

DISCUSSION

Culinary workshops are a useful tool to enhance nutrition education in a residency curriculum and may be an effective way to improve resident perceptions regarding the impact of nutrition education in the community.

Daily cooking duration and its joint effects with genetic polymorphisms on lung cancer incidence: Results from a Chinese prospective cohort study

OBJECTIVES

In this study, we conducted a prospective cohort study to investigate the joint effects of daily cooking duration with single nucleotide polymorphisms (SNPs) on lung cancer incidence.

MATERIALS AND METHODS

A total of 33,868 individuals recruited in 2013 from Dongfeng-Tongji cohort study were included in our research, in which 5178 participants were genotyped. Daily cooking duration was accessed by questionnaire, and the incident lung cancer cases were confirmed. Fifteen lung cancer related SNPs were selected according to the previous reports. We used the multiple Cox regression models to evaluate the separate and joint effects of daily cooking duration and SNPs on lung cancer incidence.

RESULTS

Each 1-h increase in daily cooking duration was associated with a 17% elevated risk of lung cancer incidence [hazard ratio (HR) (95%CI) = 1.17(1.03, 1.33)]. Specifically, subjects with daily cooking duration >2 h/day had a 2.05-fold increased incident risk of lung cancer than those without cooking [HR(95%CI) = 2.05(1.20, 3.53)] (P_trend = 0.011). The rs2395185 and rs3817963, both located at 6p21.32, were significantly associated with lung cancer incidence. Compared with no cooking subjects with rs2395185GG or rs3817963TT genotype, subjects with daily cooking >2 h/day and carrying rs2395185GT + TT genotypes had a 2.48-fold increased risk of lung cancer [HR(95%CI) = 2.48(1.03, 5.97)], and there were significant joint effects of rs3817963TC + CC with daily cooking 1-2 and >2 h/day [HR(95%CI) = 2.23(1.07, 4.64) and 2.22(1.05, 4.68), respectively].

CONCLUSIONS

Longer daily cooking duration, especially daily cooking >2 h/day, was associated with increased risk of lung cancer. There were significant joint effects of rs2395185 and rs3817963 with daily cooking duration on lung cancer incidence. This study offered a new indicator of cooking related pollution exposure and added new evidence for the joint effects of environment and genetic factors on lung cancer incidence.

Longitudinal evaluation of a household energy package on blood pressure, central hemodynamics, and arterial stiffness in China

BACKGROUND

Cardiovascular diseases are the leading contributors to disease burden in China and globally, and household air pollution exposure is associated with risk of cardiovascular disease.

OBJECTIVES

We evaluated whether subclinical cardiovascular outcomes in adult Chinese women would improve after distribution of an energy package comprised of a semi-gasifier cookstove, water heater, chimney, and supply of processed biomass fuel.

METHODS

We enrolled 204 households (n = 205 women) from 12 villages into a controlled before- and after-intervention study on cardiovascular health and air pollution in Sichuan Province. The intervention was distributed to 124 households during a government-sponsored rural energy demonstration program. The remaining 80 households received the package 18 months later at the end of the study, forming a comparison group. One woman from each household had their blood pressure (BP), central hemodynamics, and arterial stiffness measured along with exposures to air pollution and demographic and household characteristics, on up to five visits. We used a difference-in-differences mixed-effects regression approach with Bayesian inference to assess the impact of the energy package on sub-clinical cardiovascular outcomes.

RESULTS

Women who did not receive the energy package had greater mean decreases in brachial systolic (-4.1 mmHg, 95% credible interval (95%CIe) -7.3, -0.9) and diastolic BP (-2.0 mmHg, 95%CIe -3.6, -0.5) compared with women who received the package (systolic: -2.7, 95%CIe -5.0, -0.4; diastolic: -0.3, 95%CIe -1.4, 0.8) resulting in slightly positive but not statistically significant difference-in-differences effect estimates of 1.3 mmHg (95%CIe -2.5, 5.2) and 1.7 mmHg (95%CIe -0.3, 3.6), respectively. Similar trends were found for central BP, central pulse pressure, and arterial stiffness. Air pollution exposures decreased on average for both treatment groups, with a greater range of reductions among women who did not receive the package (with package: -30% to -50%; without package: +2% to -69%), likely as a result of increased use of gas fuel and electric stoves among this group. Outdoor air quality changed very little over time.

CONCLUSIONS

Gasifier stoves have been widely promoted as the next generation of 'clean-cooking' technologies, however their effectiveness in improving health in real-world settings should be carefully evaluated and communicated before scaling up their implementation.

Association between meat consumption and risk of breast cancer: Findings from the Sister Study

Meat consumption has been postulated to increase the risk of breast cancer, but this association has not been consistently seen. We examined the association between consumption of different types of meat, meat mutagens and incident invasive breast cancer. Information on consumption of different meat categories and meat cooking practice behaviors was obtained from 42,012 Sister Study participants who completed a Block 1998 Food Frequency Questionnaire at enrollment (2003-2009) and satisfied eligibility criteria. Exposure to meat type and meat mutagens was calculated, and associations with invasive breast cancer risk were estimated using multivariable Cox proportional hazards regression. During follow-up (mean, 7.6 years), 1,536 invasive breast cancers were diagnosed at least 1 year after enrollment. Increasing consumption of red meat was associated with increased risk of invasive breast cancer (HR_{highest vs. lowest quartile} :1.23, 95% CI: 1.02-1.48, p_trend = 0.01). Conversely, increasing consumption of poultry was associated with decreased invasive breast cancer risk (HR _{highest vs. lowest quartile} : 0.85; 95% CI: 0.72-1.00; p_trend = 0.03). In a substitution model with combined red meat and poultry consumption held constant, substituting poultry for red meat was associated with decreased invasive breast cancer risk (HR _{highest vs. lowest quartile} of poultry consumption: 0.72, 95% CI: 0.58-0.89). No associations were observed for cooking practices, estimated heterocyclic amines or heme iron from red meat consumption with breast cancer risk. Red meat consumption may increase the risk of invasive breast cancer, whereas poultry consumption may be associated with reduced risk. Substituting poultry for red meat could reduce breast cancer risk.

Personal exposure to PM2.5-bound organic species from domestic solid fuel combustion in rural Guanzhong Basin, China: Characteristics and health implication

Domestic solid fuels combustion produces a mass of fine particulate matter (PM_2.5). PM_2.5-bound organics, including polycyclic aromatic hydrocarbons (PAHs), oxygenated-PAHs (OPAHs), phthalate esters (PAEs) and hopanes, were quantified in indoor, outdoor and personal exposure samples collected in rural Guanzhong Basin, China. The average concentration of total quantified PAHs in personal exposure samples was 310 ± 443 ng m^-3, 1.5 times of those of indoor (211 ± 120 ng m^-3) and outdoor (189 ± 115 ng m^-3). Similar observations were found for the OPAHs and PAEs, i.e., much higher concentrations were seen in personal exposure samples. Hopanes average personal exposure concentration (13 ± 9.7 ng m^-3) was comparable to indoors (15 ± 9.7 ng m^-3) and outdoors (13 ± 9.6 ng m^-3). Among four common heating ways applied in Chinese dwelling, the highest exposure levels to PAHs, OPAHs and PAEs were found for indoor coal chunks stoves. Concentration under electric power was 1.2-4.5 folds lower than those with solid fuels in this study, proved to be the cleanest energy for the household heating. The exposures to PM_2.5 on cell viabilities were also investigated. The largest reduction of 70% on cell viabilities was seen for indoor coal chunks stove housewives, indicating that the emissions from coal combustion had the greatest cytotoxic effects. The results evidenced that the heating ways in rural area could greatly impact on the housewife health in northwestern China. Advanced heating technology and protection should be conducted to reduce the personal exposures to PM_2.5 from domestic solid fuel combustions.

A Systematic Review to Evaluate the Association between Clean Cooking Technologies and Time Use in Low- and Middle-Income Countries

Interventions implementing clean fuels to mitigate household air pollution in low- and middle-income countries have focused on environmental and health outcomes, but few have evaluated time savings. We performed a systematic review, searching for studies of clean fuel interventions that measured time use. A total of 868 manuscripts were identified that met the search criteria, but only 2 met the inclusion criteria. Both were cross-sectional and were conducted in rural India. The first surveyed the female head of household (141 using biogas and 58 using biomass) and reported 1.2 h saved per day collecting fuel and 0.7 h saved cooking, resulting in a combined 28.9 days saved over an entire year. The second surveyed the head of household (37 using biogas and 68 using biomass, 13% female) and reported 1.5 h saved per day collecting fuel, or 22.8 days saved over a year. Based on these time savings, we estimated that clean fuel use could result in a 3.8% or 4.7% increase in daily income, respectively, not including time or costs for fuel procurement. Clean fuel interventions could save users time and money. Few studies have evaluated this potential benefit, suggesting that prospective studies or randomized controlled trials are needed to adequately measure gains.

Air pollution dispersion from biomass stoves to neighboring homes in Mirpur, Dhaka, Bangladesh

BACKGROUND

Indoor air pollution, including fine particulate matter (PM2.5) and carbon monoxide (CO), is a major risk factor for pneumonia and other respiratory diseases. Biomass-burning cookstoves are major contributors to PM2.5 and CO concentrations. However, high concentrations of PM2.5 (> 1000 μg/m3) have been observed in homes in Dhaka, Bangladesh that do not burn biomass. We described dispersion of PM2.5 and CO from biomass burning into nearby homes in a low-income urban area of Dhaka, Bangladesh.

METHODS

We recruited 10 clusters of homes, each with one biomass-burning (index) home, and 3-4 neighboring homes that used cleaner fuels with no other major sources of PM2.5 or CO. We administered a questionnaire and recorded physical features of all homes. Over 24 h, we recorded PM2.5 and CO concentrations inside each home, near each stove, and outside one neighbor home per cluster. During 8 of these 24 h, we conducted observations for pollutant-generating activities such as cooking. For each monitor, we calculated geometric mean PM2.5 concentrations at 5-6 am (baseline), during biomass burning times, during non-cooking times, and over 24 h. We used linear regressions to describe associations between monitor location and PM2.5 and CO concentrations.

RESULTS

We recruited a total of 44 homes across the 10 clusters. Geometric mean PM2.5 and CO concentrations for all monitors were lowest at baseline and highest during biomass burning. During biomass burning, linear regression showed a decreasing trend of geometric mean PM2.5 and CO concentrations from the biomass stove (326.3 μg/m3, 12.3 ppm), to index home (322.7 μg/m3, 11.2 ppm), neighbor homes sharing a wall with the index home (278.4 μg/m3, 3.6 ppm), outdoors (154.2 μg/m3, 0.7 ppm), then neighbor homes that do not share a wall with the index home (83.1 μg/m3,0.2 ppm) (p = 0.03 for PM2.5, p = 0.006 for CO).

CONCLUSION

Biomass burning in one home can be a source of indoor air pollution for several homes. The impact of biomass burning on PM2.5 or CO is greatest in homes that share a wall with the biomass-burning home. Eliminating biomass burning in one home may improve air quality for several households in a community.

Very Low Food Security Status is Related to Lower Cooking Self-Efficacy and Less Frequent Food Preparation Behaviors Among College Students

OBJECTIVE

Investigate the relationships between food security status and cooking self-efficacy and food preparation behaviors among college students.

METHODS

Students living off campus while attending the University of Alabama completed an online survey between February and April 2016. Food security status was assessed using the Adult Food Security Survey Module. Cooking self-efficacy and food preparation behaviors were assessed using validated questionnaires. Multiple regression analysis was used to test for significant differences in cooking self-efficacy and food preparation scores by food security status.

RESULTS

Among respondents (n = 368), 38.3% were food insecure. Very low food secure students had significantly lower cooking self-efficacy scores and food preparation scores than food secure students (P = .001).

CONCLUSIONS AND IMPLICATIONS

Preparing meals at home is less common for very low food secure students, and these students demonstrate less confidence in cooking ability. Further study of food-related decisions and trade-offs under resource constraints are needed.

Traditional cooking practices and preferences for stove features among women in rural Senegal: Informing improved cookstove design and interventions

Nearly half the world’s population burns solid fuel for cooking, heating, and lighting. The incomplete combustion of these fuels is associated with detrimental health and environmental effects. The design and distribution of improved cookstoves that increase combustion efficiency and reduce indoor air pollution are a global priority. However, promoting exclusive and sustainable use of the improved stoves has proved challenging. In 2012, we conducted a survey in a community in rural Senegal to describe stove ownership and preferences for different stove technologies. This report aims to describe local stove and fuel use, to identify household preferences related to stove features and function, and to elicit the community perceptions of cleaner-burning stove alternatives with a focus on liquid propane gas. Similar to many resource-limited settings, biomass fuel use was ubiquitous and multiple stoves were used, even when cleaner burning alternatives were available; less than 1% of households that owned a liquid propane stove used it as the primary cooking device. Despite nearly universal use of the traditional open fire (92% of households), women did not prefer this stove when presented with other options. Propane gas, solar, and improved cookstoves were all viewed as more desirable when compared to the traditional open fire, however first-hand experience and knowledge of these stoves was limited. The stove features of greatest value were, in order: large cooking capacity, minimal smoke production, and rapid heating. Despite the low desirability and smoke emisions from the traditional open fire, its pervasive use, even in the presence of alternative stove options, may be related to its ability to satisfy the practical needs of the surveyed cooks, namely large cooking capacity and rapid, intense heat generation. Our data suggest women in this community want alternative stove options that reduce smoke exposure, however currently available stoves, including liquid propane gas, do not address all of the cooks’ preferences.

Household biomass fuel use, blood pressure and carotid intima media thickness; a cross sectional study of rural dwelling women in Southern Nigeria

BACKGROUND

Rising prevalence of cardiovascular disease requires in-depth understanding of predisposing factors. Studies show an association between air pollution and CVD but this association is not well documented in southern Nigeria where the use of biomass fuels (BMF) for domestic purposes is prevalent.

PURPOSE

This study aimed to explore the association between household BMF use and blood pressure (BP) and carotid intima media thickness (CIMT) among rural-dwelling women.

METHODS

A cross-sectional study of 389 women aged 18 years and older. Questionnaires were used to obtain data on predominant fuel used and a brief medical history. Wood, charcoal and agricultural waste were classified as BMF while kerosene, bottled gas and electricity were classified as non-BMF. Blood pressure and CIMT were measured using standard protocols. Regression analysis was used to assess the relationship between fuel type and BP, CIMT, pre-hypertension and hypertension after adjusting for confounders.

RESULTS

There was a significant difference in the mean (standard deviation) systolic BP (135.3, 26.7 mmHg vs 123.8, 22.6 mmHg; p < 0.01), diastolic BP (83.7, 18.5 mmHg vs 80.1, 13.8 mmHg; p = 0.043) and CIMT (0.63, 0.16 mm vs 0.56, 0.14 mm; p = 0.004) among BMF users compared to non-BMF users. In regression analysis, the use of BMF was significantly associated with 2.7 mmHg higher systolic BP (p = 0.040), 0.04 mm higher CIMT (p = 0.048) in addition to increased odds of pre-hypertension (OR 1.67 95% CI 1.56, 4.99, P = 0.035) but not hypertension (OR 1.23 95% CI 0.73, 2.07, P = 0.440).

CONCLUSION

In this population, there was a significant association between BMF use and increased SBP, CIMT and pre-hypertension. This requires further exploration with a large-scale longitudinal study design because there are policy implications for countries like Nigeria where a large proportion of the population still rely on BMF for domestic energy.

Characterization particulate matter from several Chinese cooking dishes and implications in health effects

Cooking fume produced by oil and food at a high temperature releases large amount of fine particulate matter (PM) which have a potential hazard to human health. This chamber study investigated particle emission characteristics originated from using four types of oil (soybean oil, olive oil, peanut oil and lard) and different kinds of food materials (meat and vegetable). The corresponding emission factors (EFs) of number, mass, surface area and volume for particles were discussed. Temporal variation of size-fractionated particle concentration showed that olive oil produced the highest number PM concentration for the entire cooking process. Multiple path particle dosimetry (MPPD) model was performed to predict deposition in the human respiratory tract. Results showed that the pulmonary airway deposition fraction was the largest. It was also found that particles produced from olive oil led to the highest deposition. We strongly recommend minimizing the moisture content of ingredients before cooking and giving priority to the use of peanut oil instead of olive oil to reduce human exposure to PM.

Characterization and cytotoxicity of PAHs in PM2.5 emitted from residential solid fuel burning in the Guanzhong Plain, China

The emission factors (EFs) of polycyclic aromatic hydrocarbons (PAHs) in PM_2.5 were measured from commonly used stoves and fuels in the rural Guanzhong Plain, China. The toxicity of the PM_2.5 also was measured using in vitro cellular tests. EFs of PAHs varied from 0.18 mg kg^-1 (maize straw charcoal burning in a clean stove) to 83.3 mg kg^-1 (maize straw burning in Heated Kang). The two largest influencing factors on PAH EFs were air supply and volatile matter proportion in fuel. Improvements in these two factors could decrease not only EFs of PAHs but also the proportion of 3-ring to 5-ring PAHs. Exposure to PM_2.5 extracts caused a concentration-dependent decline in cell viability but an increase in reactive oxygen species (ROS), tumor necrosis factor a (TNF-α) and interleukin 6 (IL-6). PM_2.5 emitted from maize burning in Heated Kang showed the highest cytotoxicity, and EFs of ROS and inflammatory factors were the highest as well. In comparison, maize straw charcoal burning in a clean stove showed the lowest cytotoxicity, which indicated a clean stove and fuel treatment were both efficient methods for reducing cytotoxicity of primary PM_2.5. The production of these bioreactive factors were highly correlated with 3-ring and 4-ring PAHs. Specifically, pyrene, anthracene and benzo(a)anthracene had the highest correlations with ROS production (R = 0.85, 0.81 and 0.80, respectively). This study shows that all tested stoves emitted PM_2.5 that was cytotoxic to human cells; thus, there may be no safe levels of exposure to PM_2.5 emissions from cooking and heating stoves using solid fuels. The study may also provide a new approach for evaluating the cytotoxicity of primary emitted PM_2.5 from solid fuel burning as well as other PM_2.5 sources.

Characterization of coal burning-derived individual particles emitted from an experimental domestic stove

Coal combustion in the domestic stoves, which is common in most parts of the Chinese countryside, can release harmful substances into the air and cause health issues. In this study, particles emitted from laboratory stove combustion of the raw powder coals were analyzed for morphologies and chemical compositions by using transmission electron microscopy (TEM) coupled with energy-dispersive X-ray spectrometry (EDX). The coal burning-derived individual particles were classified into two groups: carbonaceous particles (including soot aggregates and organic particles) and non-carbonaceous particles (including sulfate, mineral and metal particles). The non-carbonaceous particles, which constituted a majority of the coal burning-derived emissions, were subdivided into Si-rich, S-rich, K-rich, Ca-rich, and Fe-rich particles according to the elemental compositions. The Si-rich, S-rich and K-rich particles are commonly observed in the coal burning emission. The proportions for particles of different types exhibit obvious coal-issue dependence. Burning of coal with high ash yield could emit more non-carbonaceous particles, and burning of coal with high sulfur content can emit more S-rich particles. By comparing the S-rich particles from this coal burning experiment with those in the atmosphere, we draw a conclusion that some S-rich particles in the atmosphere in China could be mainly sourced from coal combustion.

Household air pollution from cooking fuel and respiratory health risks for children in Pakistan

Around 2.7 billion people in the world cook with polluting fuels, such as wood, crop residue, animal dung, charcoal, coal, and kerosene. Household air pollution from cooking with polluting fuels is recognized as a major risk factor for the disease burden. In this study, we examine the effect of using polluting fuels for cooking on the respiratory health of children in Pakistan. This study uses cross-sectional data from Pakistan Demographic and Health Survey 2012-13, with the sample size of 11,040 children under 5 years of age. Using logistic regression model, we control for factors such as averting activities, child characteristics, household characteristics, mother characteristics, and the unobserved factors using fixed effects. The results show that children in households using polluting fuels are 1.5 times more likely to have symptoms of acute respiratory infection (ARI) than children in households using cleaner fuels.

Characterization and health risk assessment of airborne pollutants in commercial restaurants in northwestern China: Under a low ventilation condition in wintertime

Impacts on indoor air quality of dining areas from cooking activities were investigated in eight categories of commercial restaurants including Szechwan Hotpot, Hunan, Shaanxi Noodle, Chinese Barbecue, Chinese Vegetarian, Korean Barbecue, Italian, and Indian, in Northwestern China during December 2011 to January 2012. Chemical characterization and health risk assessment for airborne carbonyls, and particulate-bound polycyclic aromatic hydrocarbons (PAHs) and heavy metals were conducted under low ventilation conditions in wintertime. The highest total quantified carbonyls (Σ_carbonyls) concentration of 313.6μgm^-3 was found in the Chinese Barbecue, followed by the Szechwan Hotpot (222.6μgm^-3) and Indian (221.9μgm^-3) restaurants. However, the highest Σ_carbonyls per capita was found at the Indian restaurant (4500μgcapita^-1), suggesting that cooking methods such as stir-fly and bake for spices ingredients released more carbonyls from thermal cooking processes. Formaldehyde, acetaldehyde, and acetone were the three most abundant species, totally accounting for >60% of mass concentrations of the Σ_carbonyls. Phenanthrene, chrysene, and benzo[a]anthracene were the three most abundant PAHs. Low molecular weight fraction (ΣPAHs_≤178) had the highest contributions accounting for 40.6%-65.7%, much greater than their heaver counterparts. Diagnostic PAHs ratios suggest that cooking fuel and environmental tobacco smoke (ETS) contribute to the indoor PAHs profiles. Lead was the most abundant heavy metal in all sampled restaurants. High quantity of nickel was also found in samples due to the emissions from stainless-steel made kitchen utensils and cookware and ETS. Cancer risk assessments on the toxic substances demonstrate that the working environment of dining areas were hazard to health. Formation of reactive organic species (ROS) from the cooking activities was evidenced by measurement of hydroxyl radical (OH) formed from simulating particulate matter (PM) react with surrogate lung fluid. The highest OH concentration of 294.4ngm^-3 was detected in Chinese Barbecue. In addition, the elevation of the concentrations of PM and OH after non-dining periods implies that the significance of formation of oxidizing-active species indoor at poor ventilation environments.

Impacts of stove use patterns and outdoor air quality on household air pollution and cardiovascular mortality in southwestern China

BACKGROUND

Decades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified.

METHODS

We measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships.

RESULTS

Mean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced.

CONCLUSIONS

Clean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Pollutant emissions from residential combustion and reduction strategies estimated via a village-based emission inventory in Beijing

Accurate estimation of pollutant emissions from household solid fuel combustion has been a challenging issue in developing regions, especially in the heavily polluted northern China region. Basing on a survey of residential household energy use in all villages in Beijing, this study developed a village-based emission inventory of PM_2.5, SO₂, NOx, and NMVOCs emitted from household combustion in Beijing, as well as three emission control scenarios. Notably, 3805 kt and 556 kt of coal were used for household heating and cooking in 2015, respectively. The emissions of NO_X, NMVOCs, SO₂, and PM_2.5forhousehold heating totaled11.5 kt, 29.3 kt, 43.1 kt, and 34.7 kt in 2015, respectively, while those for household cooking totaled 1.55 kt, 4.02 kt, 6.55 kt, and 3.99 kt. Emissions from household heating contributed to∼70% of PM_2.5 and ∼60% of SO₂ emissions in winter. Additionally, downtown Beijing is surrounded by polluted suburbs. A coal forbiddance policy (e.g. "coal to gas") could gradually improve the air quality in urban Beijing.

Household air pollution and personal exposure to air pollutants in rural China - A review

Solid fuels, an important source of severe Household Air Pollution (HAP) linked to many adverse health outcomes, has been widely consumed around the world. China consumes large amounts of solid fuels and suffers from serious indoor and outdoor air pollution. Though global HAP issues had been reviewed in previous literatures, peer-reviewed Chinese publications were seldom included in those reviews. We conducted a literature review on the studies of HAP and personal exposure in rural China with inputs from peer-reviewed publications in both English and Chinese. A total of 36,572 articles were retrieved, 294 were read in full text, of which 92 were included in final data extraction and in-depth analysis. Although HAP is a very serious issue in China, studies on either HAP or personal exposure assessment were very limited. From existing studies, levels of air pollutants including carbon monoxide, sulfur dioxide, particulate matter (PM), organic carbon, elemental carbon, polycyclic aromatic hydrocarbons (PAHs), etc., in indoor and ambient air were analyzed for their temporal and spatial variations, and the differences across different fuel types were compared. The studies showed that PM and PAHs levels in most rural homes exceeded the World Health Organization (WHO) and Chinese National Standards, especially during the heating season in northern China. Replacing traditional fuels with cleaner ones (such as liquid petroleum gas (LPG), biogas or electricity) was considered as the most appropriate way to mitigate HAP. The daily exposure to PM and PAHs from using LPG, biogas or electricity was considerably lower than that from using traditional solid fuels. However, the level was still higher than the guideline values for PM and PAHs set by WHO to protect human health. To achieve a more effective control, the current data gap need to be closed and suggestions for future research were discussed in this review.

Characterizing exposure to household air pollution within the Prospective Urban Rural Epidemiology (PURE) study

BACKGROUND

Household air pollution (HAP) from combustion of solid fuels is an important contributor to disease burden in low- and middle-income countries (LIC, and MIC). However, current HAP disease burden estimates are based on integrated exposure response curves that are not currently informed by quantitative HAP studies in LIC and MIC. While there is adequate evidence supporting causal relationships between HAP and respiratory disease, large cohort studies specifically examining relationships between quantitative measures of HAP exposure with cardiovascular disease are lacking.

OBJECTIVE

We aim to improve upon exposure proxies based on fuel type, and to reduce exposure misclassification by quantitatively measuring exposure across varying cooking fuel types and conditions in diverse geographies and socioeconomic settings. We leverage technology advancements to estimate household and personal PM2.5 (particles below 2.5 μm in aerodynamic diameter) exposure within the large (N~250,000) multi-country (N~26) Prospective Urban and Rural Epidemiological (PURE) cohort study. Here, we detail the study protocol and the innovative methodologies being used to characterize HAP exposures, and their application in epidemiologic analyses.

METHODS/DESIGN

This study characterizes HAP PM2.5 exposures for participants in rural communities in ten PURE countries with >10% solid fuel use at baseline (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, South Africa, Tanzania, and Zimbabwe). PM2.5 monitoring includes 48-h cooking area measurements in 4500 households and simultaneous personal monitoring of male and female pairs from 20% of the selected households. Repeat measurements occur in 20% of households to assess impacts of seasonality. Monitoring began in 2017, and will continue through 2019. The Ultrasonic Personal Aerosol Sampler (UPAS), a novel, robust, and inexpensive filter based monitor that is programmable through a dedicated mobile phone application is used for sampling. Pilot study field evaluation of cooking area measurements indicated high correlation between the UPAS and reference Harvard Impactors (r = 0.91; 95% CI: 0.84, 0.95; slope = 0.95). To facilitate tracking and to minimize contamination and analytical error, the samplers utilize barcoded filters and filter cartridges that are weighed pre- and post-sampling using a fully automated weighing system. Pump flow and pressure measurements, temperature and RH, GPS coordinates and semi-quantitative continuous particle mass concentrations based on filter differential pressure are uploaded to a central server automatically whenever the mobile phone is connected to the internet, with sampled data automatically screened for quality control parameters. A short survey is administered during the 48-h monitoring period. Post-weighed filters are further analyzed to estimate black carbon concentrations through a semi-automated, rapid, cost-effective image analysis approach. The measured PM2.5 data will then be combined with PURE survey information on household characteristics and behaviours collected at baseline and during follow-up to develop quantitative HAP models for PM2.5 exposures for all rural PURE participants (~50,000) and across different cooking fuel types within the 10 index countries. Both the measured (in the subset) and the modelled exposures will be used in separate longitudinal epidemiologic analyses to assess associations with cardiopulmonary mortality, and disease incidence.

DISCUSSION

The collected data and resulting characterization of cooking area and personal PM2.5 exposures in multiple rural communities from 10 countries will better inform exposure assessment as well as future epidemiologic analyses assessing the relationships between quantitative estimates of chronic HAP exposure with adult mortality and incident cardiovascular and respiratory disease. This will provide refined and more accurate exposure estimates in global CVD related exposure-response analyses.

Meat Cooking Methods and Risk of Type 2 Diabetes: Results From Three Prospective Cohort Studies

OBJECTIVE

To examine open-flame and/or high-temperature cooking (grilling/barbecuing, broiling, or roasting) and doneness preferences (rare, medium, or well done) for red meat, chicken, and fish in relation to type 2 diabetes (T2D) risk among U.S. adults who consumed animal flesh regularly (≥2 servings/week).

RESEARCH DESIGN AND METHODS

The prospective studies included 52,752 women from the Nurses' Health Study (NHS) (followed during 1996-2012), 60,809 women from NHS II (followed during 2001-2013), and 24,679 men from the Health Professionals Follow-Up Study (HPFS) (followed during 1996-2012) who were free of diabetes, cardiovascular disease, and cancer at baseline. Incident cases of T2D were confirmed by validated supplementary questionnaires.

RESULTS

We documented 7,895 incident cases of T2D during 1.74 million person-years of follow-up. After multivariate adjustments including baseline BMI and total consumption of red meat, chicken, and fish, higher frequency of open-flame and/or high-temperature cooking was independently associated with an elevated T2D risk. When comparing open-flame and/or high-temperature cooking >15 times/month with <4 times/month, the pooled hazard ratio (HR) (95% CI) of T2D was 1.28 (1.18, 1.39; Ptrend <0.001). When comparing the extreme quartiles of doneness-weighted frequency of high-temperature cooking, the pooled HR (95% CI) of T2D was 1.20 (1.12, 1.28; Ptrend <0.001). These associations remained significant when red meat and chicken were examined separately. In addition, estimated intake of heterocyclic aromatic amines was also associated with an increased T2D risk.

CONCLUSIONS

Independent of consumption amount, open-flame and/or high-temperature cooking for both red meat and chicken is associated with an increased T2D risk among adults who consume animal flesh regularly.

Who's cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016

BACKGROUND

While US home cooking declined in the late twentieth century, it is unclear whether the trend has continued. This study examines home cooking from 2003 to 2016 by gender, educational attainment, and race/ethnicity.

METHODS

Nationally representative data from the American Time Use Study from 2003 to 2016 and linear regression models were used to examine changes in the percent of adults aged 18-65 years who cook and their time spent cooking, with interactions to test for differential changes by demographic variables of gender, education, and race/ethnicity.

RESULTS

Cooking increased overall from 2003 to 2016. The percent of college-educated men cooking increased from 37.9% in 2003 to 51.9% in 2016, but men with less than high school education who cook did not change (33.2% in 2016) (p < 0.05). College-educated women who cook increased from 64.7% in 2003 to 68.7% in 2016, while women with less than high school education had no change (72.3% in 2016) (p < 0.05). Women with less education spent more time cooking per day than high-educated women, but the reverse was true for men. Among men, the percent who cook increased for all race/ethnic groups except non-Hispanic blacks. Among women, only non-Hispanic whites increased in percent who cook. Among both men and women, non-Hispanic blacks had the lowest percentage who cooked, and non-Hispanic others spent the greatest amount of time cooking.

CONCLUSIONS

Home cooking in the United States is increasing, especially among men, though women still cook much more than men. Further research is needed to understand whether the heterogeneity in home cooking by educational attainment and race/ethnicity observed here contributes to diet-related disparities in the United States.

Associations between daily cooking duration and the prevalence of diabetes and prediabetes in a middle-aged and elderly Chinese population: A cross-sectional study

Experimental and epidemiological studies indicated that ambient air pollution was positively associated with diabetes. Few studies investigated the associations between household air pollution, for example, daily cooking duration and diabetes or prediabetes. We conducted a cross-sectional study to investigate the associations of daily cooking duration with the prevalence of diabetes and prediabetes among a middle-aged and elderly population. A total of 26 089 individuals (11 250 males and 14 839 females) derived from the Dongfeng-Tongji cohort study were included. Daily cooking duration was assessed by questionnaire. Diabetes and prediabetes were identified according to the criterion of American Diabetes Association. No significant association was observed between daily cooking duration and the prevalence risk of diabetes (odds ratio[OR] = 0.97, 95% confidence interval[CI]: [0.81-1.16], P for trend = .74); however, longer daily cooking duration was associated with higher prevalence risk of prediabetes (OR = 1.26, 95% CI: 1.07-1.47; P for trend = .003) and hyperglycemia (OR = 1.21, 95% CI: 1.05-1.41; P for trend = .005). Our study suggested that daily cooking duration was not associated with diabetes but with higher prevalence risk of prediabetes/hyperglycemia in a middle-aged and elderly Chinese population.

Air pollution and inhalation exposure to particulate matter of different sizes in rural households using improved stoves in central China

Household air pollution is considered to be among the top environmental risks in China. To examine the performance of improved stoves for reduction of indoor particulate matter (PM) emission and exposure in rural households, individual inhalation exposure to size-resolved PM was investigated using personal portable samplers carried by residents using wood gasifier stoves or improved coal stoves in a rural county in Central China. Concentrations of PM with different sizes in stationary indoor and outdoor air were also monitored at paired sites. The stationary concentrations of size-resolved PM in indoor air were greater than those in outdoor air, especially finer particles PM_0.25. The daily averaged exposure concentrations of PM_0.25, PM_1.0, PM_2.5 and total suspended particle for all the surveyed residents were 74.4±41.1, 159.3±74.3, 176.7±78.1 and 217.9±78.1μg/m³, respectively. Even using the improved stoves, the individual exposure to indoor PM far exceeded the air quality guideline by WHO at 25μg/m³. Submicron particles PM_1.0 were the dominant PM fraction for personal exposure and indoor and outdoor air. Personal exposure exhibited a closer correlation with indoor PM concentrations than that for outdoor concentrations. Both inhalation exposure and indoor air PM concentrations in the rural households with gasifier firewood stoves were evidently lower than the reported results using traditional firewood stoves. However, local governments in the studied rural areas should exercise caution when widely and hastily promoting gasifier firewood stoves in place of improved coal stoves, due to the higher PM levels in indoor and outdoor air and personal inhaled exposure.

The impact of biogas and fuelwood use on institutional kitchen air quality in Kampala, Uganda

Experts have suggested that microscale biogas systems offer a source of renewable energy that improves indoor air quality, but such impacts have not been directly measured. This study documented cooking behaviors and measured 2.5-μm particulate matter (PM_2.5 ), carbon monoxide (CO), and sulfur dioxide (SO₂ ) concentrations within 14 institutional kitchens in Kampala, Uganda, that prepare meals using biogas (n=5), a mixture of biogas and fuelwood (n=3), and fuelwood (n=6). Small institutions (10-30 people) with biogas kitchens had 99% lower concentrations of PM_2.5 (21 μg/m³ ) than fuelwood kitchens (3100 μg/m³ ). Larger institutions (>100 people) had biogas systems that produced insufficient gas and relied on fuelwood to meet over 90% of their energy needs. PM_2.5 concentrations in these biogas-firewood kitchens were equivalent to concentrations in fuelwood kitchens. Although concentrations of hydrogen sulfide (H₂ S) in biogas were as high as 2000 ppm, 75% of systems had undetectable H₂ S levels (<100 ppm) in the biogas. Kitchens using biogas with high H₂ S had correspondingly higher SO₂ concentrations in the kitchen air. However, even the highest SO₂ concentration in biogas kitchens (150 μg/m³ ) was lower than SO₂ concentration in fuelwood kitchens (390 μg/m³ ). The results suggest that biogas systems can offer air quality improvements if sized properly for energy demands.

Domestic solid fuel combustion in an adult population in Nigeria: A cross sectional analysis of association with respiratory symptoms, quality of life and lung function

BACKGROUND AND OBJECTIVES

We examined the association of respiratory symptoms, health status, and lung function with the use of solid fuel (wood, charcoal, coal or crop residue) for cooking or heating in a predominantly non-smoking population.

METHODS

Using the protocol of the Burden of Obstructive Lung Diseases (BOLD) initiative, we collected representative population data using questionnaires and spirometry tests. We categorized solid fuel use into 'never user', 'ex user' and 'current user' based on responses to the survey. We developed regression models to evaluate the relation between use of solid fuel and the prevalence of respiratory symptoms, quality of life and lung function adjusting for confounding variables.

RESULTS

Out of 1147 respondents with complete information on domestic fuel type, 33% were 'never-users', 19% were 'ex-users' while 48% reported current use of solid fuel for domestic cooking and/or indoor heating. Compared with never-users, current solid fuel users were more likely to report cough (OR: 1.7, 95% CI: 1.0, 2.9), cough or phlegm (OR: 1.6, 95% CI: 1.0, 2.5) and the association was stronger among women (OR: 3.0, 95% CI: 1.3, 7.1 and OR: 2.3, 95% CI: 1.1, 5.2, respectively). Current solid fuel users also had lower mental health status (coefficient: ?1.5, 95% CI: ?2.8, - 0.2) compared with the group of never-users. Current or previous domestic use of solid fuels for cooking or heating was not associated with higher prevalence of chronic airflow obstruction (FEV₁/FVC < LLN).

CONCLUSIONS

Using solid fuel for domestic cooking or heating was associated with a higher risk of cough or phlegm and a lower mental quality of life. However we found no significant effect in the prevalence of chronic airflow obstruction in Ife, Nigeria.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]

INTRODUCTION

In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women.

AIM

To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia.

METHODS

Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions.

RESULTS

We found 81 women exposed to biomass for a period > or equal to 20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6 <70 % of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women.

CONCLUSION

The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can be consistent with COPD.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]

INTRODUCTION

In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women.

AIM

To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia.

METHODS

Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions.

RESULTS

We found 81 women exposed to biomass for a period of≥20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6<70% of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women.

CONCLUSION

The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can consistent with COPD.

A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial

BACKGROUND

WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children.

METHODS

We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623.

FINDINGS

We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89-16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72-16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91-1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37-2·23]; p=0·83).

INTERPRETATION

We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed.

FUNDING

Medical Research Council, UK Department for International Development, and Wellcome Trust.

Patterns of domestic exposure to carbon monoxide and particulate matter in households using biomass fuel in Janakpur, Nepal

Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m3 (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.

Compliance With Recommended Food Safety Practices in Television Cooking Shows

OBJECTIVE

Examine compliance with recommended food safety practices in television cooking shows.

METHODS

Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows.

RESULTS

Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned.

CONCLUSIONS AND IMPLICATIONS

There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers.

Household air pollution and lung cancer risk among never-smokers in Nepal

More than half of the global population relies on biomass fuels (wood, charcoal, crop residue, dung) for cooking and/or heating purposes. Household air pollution (HAP) resulting from the use of these solid fuels is of particular concern, given the overall prevalence as well as the intensity of exposure and the range of potential adverse health outcomes. Long term exposure to HAP is a major public health concern, particularly among women and children in low and middle income countries. In this study, we investigated the association between exposure to HAP resulting from combustion of biomass and lung cancer risk among Nepalese population. Using a hospital-based case-control study (2009-2012), we recruited 606 lung cancer cases and 606 healthy controls matched on age (±5 years), gender, and geographical residence. We used unconditional logistic regression to compute odds ratios (ORs) and 95% Confidence Intervals (95% CI) for lung cancer risk associated with HAP exposures, adjusting for potential confounders (tobacco use, TB status, SES, age, gender, ethnicity, and exposure to second hand smoke. In our overall analysis, we observed increased risk of lung cancer among those who were exposed to HAPs (OR: 1.77, 95% CI: 1.00-3.14). A more detailed analysis stratified by smoking status showed considerably higher risk of lung cancer associated with increasing duration of exposure to HAP from biomass combustion, with evidence of a borderline exposure-response relationship (Ptrend=0.05) that was more pronounced among never-smokers (Ptrend=0.01). Our results suggest that chronic exposure to HAP resulting from biomass combustion is associated with increased lung cancer risk, particularly among never-smokers in Nepal.