Household air pollution from the combustion of biomass and coal is estimated to cause approximately 780,000 premature deaths a year in India. The government has responded by promoting uptake of ...liquefied petroleum gas (LPG) by tens of millions of poor rural families. Many poor households with new LPG stoves, however, continue to partially use traditional smoky chulhas. Our primary objective was to evaluate three strategies to transition pregnant women in rural Maharashtra to exclusive use of LPG for cooking. We also measured reductions in kitchen concentrations of PM2.5 before and after our interventions. Our core intervention was a free stove, 2 free LPG cylinders (one on loan until delivery), and repeated health messaging. We measured stove usage of both the traditional and intervention stoves until delivery. In households that received the core intervention, an average of 66% days had no indoor cooking on a chulha. In an adjacent area, we evaluated a conditional cash transfer (CCT) based on usage of LPG in addition to the core intervention. Results were less successful, due to challenges implementing the CCT. Pregnant women in a third nearby area received the core intervention plus a maximum of one 14.2 kg cylinder per month of free fuel. In their homes, 90% of days had no indoor cooking on a chulha. On average, exclusive LPG use decreased kitchen concentrations of PM2.5 by approximately 85% (from 520 to 72 μg/m3). 85% of participating households agreed to pay the deposit on the 2nd cylinder. This high purchase rate suggests they valued how the second cylinder permitted continuous LPG supply. A program to increase access to second cylinders may, thus, be a straightforward way to encourage use of clean fuels in rural areas.
•Access to clean fuels is increasing in India; programs to enhance usage are limited.•Targeting pregnant women fits within Indian intervention modes.•PM2.5 levels decreased from 505 to 72 μg/m3, an ~85% reduction, when using LPG.•Providing free fuel resulted in, on average, 90% of days with exclusive LPG use.•85% of the poor women bought a 2nd LPG cylinder to ease fuel supply constraints.
•The evidence for the effects of air pollution on lung function of young adults is scarce.•We evaluated annual average PM2.5outdoors at residence and biomass cooking fuel.•We observed negative ...associations for ambient PM2.5 and biomass cooking fuel and lung function, although imprecise for ambient PM2.5.
Although there is evidence for the association between air pollution and decreased lung function in children, evidence for adolescents and young adults is scarce. For a peri-urban area in India, we evaluated the association of ambient PM2.5 and household air pollution with lung function for young adults who had recently attained their expected maximum lung function.
We measured, using a standardized protocol, forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in participants aged 20–26 years from the third follow-up of the population-based APCAPCS cohort (2010–2012) in 28 Indian villages. We estimated annual average PM2.5outdoors at residence using land-use regression. Biomass cooking fuel (a proxy for levels of household air pollution) was self-reported. We fitted a within-between linear-mixed model with random intercepts by village, adjusting for potential confounders.
We evaluated 1,044 participants with mean age of 22.8 (SD = 1) years (range 20–26 years); 327 participants (31%) were female. Only males reported use of tobacco smoking (9% of all participants, 13% of males). The mean ambient PM2.5 exposure was 32.9 (SD = 2.8) µg/m3; 76% reported use of biomass as cooking fuel. The adjusted association between 1 µg/m3 increase in PM2.5 was −27 ml (95% CI, −89 to 34) for FEV1 and −5 ml (95% CI, −93 to 76) for FVC. The adjusted association between use of biomass was −112 ml (95% CI, −211 to −13) for FEV1 and −142 ml (95% CI, −285 to 0) for FVC. The adjusted association was of greater magnitude for those with unvented stove (−158 ml, 95% CI, −279 to −36 for FEV1 and −211 ml, 95% CI, −386 to −36 for FVC).
We observed negative associations between ambient PM2.5 and household air pollution and lung function in young adults who had recently attained their maximum lung function.
Scalable exposure assessment approaches that capture personal exposure to particles for purposes of epidemiology are currently limited, but valuable, particularly in low-/middle-income countries ...where sources of personal exposure are often distinct from those of ambient concentrations. We measured 2 × 24-h integrated personal exposure to PM
and black carbon in two seasons in 402 participants living in peri-urban South India. Means (sd) of PM
personal exposure were 55.1(82.8) µg/m
for men and 58.5(58.8) µg/m
for women; corresponding figures for black carbon were 4.6(7.0) µg/m
and 6.1(9.6) µg/m
. Most variability in personal exposure was within participant (intra-class correlation ~20%). Personal exposure measurements were not correlated (R
< 0.2) with annual ambient concentration at residence modeled by land-use regression; no subgroup with moderate or good agreement could be identified (weighted kappa ≤ 0.3 in all subgroups). We developed models to predict personal exposure in men and women separately, based on time-invariant characteristics collected at baseline (individual, household, and general time-activity) using forward stepwise model building with mixed models. Models for women included cooking activities and household socio-economic position, while models for men included smoking and occupation. Models performed moderately in terms of between-participant variance explained (38-53%) and correlations between predictions and measurements (R
: 0.30-0.50). More detailed, time-varying time-activity data did not substantially improve the performance of the models. Our results demonstrate the feasibility of predicting personal exposure in support of epidemiological studies investigating long-term particulate matter exposure in settings characterized by solid fuel use and high occupational exposure to particles.
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•We evaluated personal exposure to PM2.5 and BC in adults from peri-urban India.•PM2.5 was associated with vascular damage by three cardiovascular markers in men.•PM2.5 was ...nonlinearly associated with increased augmentation index in men.•Both PM2.5 and BC were positively associated with augmentation index AIx in women.
Air pollution is a leading preventable risk factor for cardiovascular diseases. Previous studies mostly relied on concentrations at residence, which might not represent personal exposure. Personal air pollution exposure has a greater variability compared with levels of ambient air pollution, facilitating evaluation of exposure-response functions and vascular pathophysiology. We aimed to evaluate the association between predicted annual personal exposure to PM2.5 and black carbon (BC) and three vascular damage markers in peri-urban South India.
We analyzed the third wave of the APCAPS cohort (2010–2012), which recruited participants from 28 villages. We used predicted personal exposure to PM2.5 and BC derived from 610 participant-days of 24 h average gravimetric PM2.5 and BC measurements and predictors related to usual time-activity. Outcomes included carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx). We fit linear mixed models, adjusting for potential confounders and accounting for the clustered data structure. We evaluated nonlinear associations using generalized additive mixed models.
Of the 3017 participants (mean age 38 years), 1453 (48%) were women. The average PM2.5 exposure was 51 µg/m3 (range 13–85) for men, and 61 µg/m3 (range 40–120) for women, while the average BC was 4 µg/m3 (range 3–7) for men and 8 µg/m3 (range 3–22) for women. A 10 μg/m3 increase of PM2.5 was positively associated with CIMT (0.026 mm, 95% CI 0.014, 0.037), cf-PWV (0.069 m/s, 95% CI 0.008, 0.131) and AIx (0.8%, 95% CI 0.3, 1.3) among men. The exposure-response function for PM2.5 and AIx among men showed non-linearity, particularly within the exposure range dominated by tobacco smoking and occupational exposures. Both PM2.5 and BC were positively associated with AIx among women (0.6%, 95% CI 0.2, 1.0, per 10 μg/m3 PM2.5; 0.5%, 95% CI 0.1, 0.8, per 2 μg/m3 BC).
Personal exposure to particulate matter was associated with vascular damage in a peri-urban population in South India. Personal exposure to particulate matter appears to have gender-specific effects on the type of vascular damage, potentially reflecting differences in sources of personal exposure by gender.
Background and Objective:
The causal role of maternal nutrition in orofacial clefts is uncertain. We tested hypotheses that low maternal vitamin B12 and low folate status are each associated with an ...increased risk of isolated cleft lip with or without cleft palate (CL±P) in a case–control study in Tamil Nadu state, India.
Methods:
Case-mothers of CL±P children (n = 47) and control-mothers of unaffected children (n = 50) were recruited an average of 1.4 years after birth of the index child and plasma vitamin B12, methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured at that time. Logistic regression analyses estimated associations between nutrient biomarkers and case–control status.
Results:
Odds ratios (ORs) contrasting biomarker levels showed associations between case-mothers and low versus high plasma vitamin B12 (OR = 2.48, 95% CI, 1.02-6.01) and high versus low plasma MMA, an indicator of poor B12 status (OR = 3.65 95% CI, 1.21-11.05). Case–control status was not consistently associated with folate or tHcy levels. Low vitamin B12 status, when defined by a combination of both plasma vitamin B12 and MMA levels, had an even stronger association with case-mothers (OR = 6.54, 95% CI, 1.33-32.09).
Conclusions:
Mothers of CL±P children in southern India were 6.5 times more likely to have poor vitamin B12 status, defined by multiple biomarkers, compared to control-mothers. Further studies in populations with diverse nutritional backgrounds are required to determine whether poor maternal vitamin B12 or folate levels or their interactions are causally related to CL±P.
The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four ...low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial.
We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice - at 1 and 2 months - after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers.
In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 IQR:71-258 and 27 μg/m3 IQR:20-47, while corresponding personal exposures were 75 μg/m3 IQR:55-104 and 36 μg/m3 IQR:26-46, respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 IQR:49-127 at baseline and 25 μg/m3 IQR:18-35 after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 IQR:19-27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance.
An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs.
ClinicalTrials.Gov. NCT02944682 ; Prospectively registered on October 17, 2016.
Background
: In India, approximately 66% of households rely on dung or woody biomass as fuels for cooking. These fuels are burned under inefficient conditions, leading to household air pollution ...(HAP) and exposure to smoke containing toxic substances. Large-scale intervention efforts need to be informed by careful piloting to address multiple methodological and sociocultural issues. This exploratory study provides preliminary data for such an exercise from Palwal District, Haryana, India.
Methods
: Traditional cooking practices were assessed through semi-structured interviews in participating households. Philips and Oorja, two brands of commercially available advanced cookstoves with small blowers to improve combustion, were deployed in these households. Concentrations of particulate matter (PM) with a diameter <2.5 μm (PM
2.5
) and carbon monoxide (CO) related to traditional stove use were measured using real-time and integrated personal, microenvironmental samplers for optimizing protocols to evaluate exposure reduction. Qualitative data on acceptability of advanced stoves and objective measures of stove usage were also collected.
Results
: Twenty-eight of the thirty-two participating households had outdoor primary cooking spaces. Twenty households had liquefied petroleum gas (LPG) but preferred traditional stoves as the cost of LPG was higher and because meals cooked on traditional stoves were perceived to taste better. Kitchen area concentrations and kitchen personal concentrations assessed during cooking events were very high, with respective mean PM
2.5
concentrations of 468 and 718 µg/m
3
. Twenty-four hour outdoor concentrations averaged 400 µg/m
3
. Twenty-four hour personal CO concentrations ranged between 0.82 and 5.27 ppm. The Philips stove was used more often and for more hours than the Oorja.
Conclusions
: The high PM and CO concentrations reinforce the need for interventions that reduce HAP exposure in the aforementioned community. Of the two stoves tested, participants expressed satisfaction with the Philips brand as it met the local criteria for usability. Further understanding of how the introduction of an advanced stove influences patterns of household energy use is needed. The preliminary data provided here would be useful for designing feasibility and/or pilot studies aimed at intervention efforts locally and nationally.
Household air pollution (HAP) resulting from the use of solid cooking fuels is a leading contributor to the burden of disease in India. Advanced combustion cookstoves that reduce emissions from ...biomass fuels have been considered potential interventions to reduce this burden. Relatively little effort has been directed, however, to assessing the concentration and exposure changes associated with the introduction of such devices in households.
The aim of this study was to describe HAP exposure patterns in pregnant women receiving a forced-draft advanced combustion cookstove (Philips model HD 4012) in the SOMAARTH Demographic Development & Environmental Surveillance Site (DDESS) Palwal District, Haryana, India. The monitoring was performed as part of a feasibility study to inform a potential large-scale HAP intervention (Newborn Stove trial) directed at pregnant women and newborns.
This was a paired comparison exercise study with measurements of 24-hour personal exposures and kitchen area concentrations of carbon monoxide (CO) and particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), before and after the cookstove intervention. Women (N = 65) were recruited from 4 villages of SOMAARTH DDESS. Measurements were performed between December 2011 and March 2013. Ambient measurements of PM2.5 were also performed throughout the study period.
Measurements showed modest improvements in 24-hour average concentrations and exposures for PM2.5 and CO (ranging from 16% to 57%) with the use of the new stoves. Only those for CO showed statistically significant reductions.
Results from the present study did not support the widespread use of this type of stove in this population as a means to reliably provide health-relevant reductions in HAP exposures for pregnant women compared with open biomass cookstoves. The feasibility assessment identified multiple factors related to user requirements and scale of adoption within communities that affect the field efficacy of advanced combustion cookstoves as well as their potential performance in HAP intervention studies.
•Volatile organic compounds (VOCs) released from household cooking fuel are a serious public health concern in low and middle income countries (LMICs).•21 non-methane VOCs were collected on mixed-bed ...thermal desorption tubes from biomass, kerosene and liquefied petroleum gas (LPG) fuel using kitchens.•Total BETXS levels in different fuel using kitchens followed the order kerosene > biomass > LPG.•1,2,3-trichloropropane, benzene, 1,4-dichlorobenze,1,2-dibromoethane and chloroform contributed maximally to lifetime cancer risk.•Estimated lifetime excess cancer risk cases were highest among biomass fuel users followed by kerosene and LPG fuel users.
Volatile organic compounds (VOCs) from household cook-fuel use are a major public health concern in low and middle income countries (LMICs), but health risk assessments have largely been based on measurements of fine particulate matter. We report results from cooking period measurements of 21 non-methane VOCs (NMVOCs) and estimated lifetime cancer risk for women cooks in the Tamil Nadu Air Pollution and Health Effects (TAPHE) cohort in Southern India. We enrolled 112 (56 biomass, 23 kerosene and 33 liquefied petroleum gas (LPG) using) TAPHE households to perform kitchen area measurements during the cooking period. VOC samples were collected on mixed-bed sorbent thermal desorption tubes using low-volume air samplers and analyzed using automated thermal desorption on a GC-MS system. Pentafluorobenzene, 1,4-difluorobenzene and chlorobenzene-d5 were used as internal standards that provided recoveries ranging from 81.7% to 119.9%. Total VOC concentrations were 4617 µg/m3, 2839 µg/m3 and 1639 µg/m3 while total BTEXS (i.e. benzene, toluene, ethylbenzene, m,p-xylene, o-xylene and styrene) concentrations were 139 µg/m3,121 µg/m3 and 245 µg/m3 among biomass, LPG and kerosene using households, respectively. Sampling season, type of food cooked and kitchen ventilation were significantly associated with measured total NMVOC concentrations. Lifetime cancer risks were estimated to be 2.93 × 10−3, 1.55 × 10−4 and 8.18 × 10−5, for biomass, kerosene and LPG fuel users, respectively with 1,2,3-trichloropropane, benzene, 1,4-dichlorobenze, 1,2-dibromoethane and chloroform contributing maximally to excess cancer risks. Health risk assessments for women cooks in LMICs should be expanded to include NMVOCs as these risks may not be adequately addressed through measurements of fine particulate matter (PM2.5) pollution alone.
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