Wood stove interventions and child respiratory infections in rural communities

农村社区的木炉干预和儿童呼吸道感染

• 批准号: 8693259
• 负责人: Curtis William Noonan
• 金额: $ 58.02万
• 依托单位: UNIVERSITY OF MONTANA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-19 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8693259
• 关键词: 5 year old; Accounting; Acute; Age-Years; Air; Alaska; Alaska Native; Area; Asthma; Biomass; Burn injury; Cause of Death; Child; Childhood; Communities; Cookstove; Detection; Developing Countries; Economically Deprived Population; Education; Educational Intervention; Exposure to; Geographic Locations; Health; Health Services Accessibility; Heating; Home environment; Hospitalization; Incidence; Indoor Air Quality; Infant; Inhalation Exposure; Intervention; Intervention Trial; Life; Lower Respiratory Tract Infection; Maintenance; Modeling; Montana; Morbidity - disease rate; Native Americans; Navajo; Outcome; Particulate Matter; Placebo Control; Placebos; Population; Randomized; Recurrence; Relative (related person); Research; Research Infrastructure; Reservations; Respiratory System; Respiratory Tract Infections; Respiratory tract structure; Risk; Risk Factors; Rural; Rural Community; Sampling; Site; Smoke; Source; Technology; Testing; Thermometers; Training; Translating; Translations; United States; Wheezing; Wood material; Wood stove; air filter; air filtration; arm; base; comparative efficacy; cooking; cost; cost effective; efficacy testing; evidence base; experience; follow-up; health disparity; improved; instrument; meter; new technology; operation; primary outcome; programs; public health relevance; randomized trial; respiratory; rural area; treatment strategy

DESCRIPTION (provided by applicant): Acute lower respiratory tract infections (LRTIs) account for more than 27% of all hospitalizations among US children under five years of age, with recurrent LRTIs in children a recognized risk factor for asthma. Within rural areas of Montana, Alaska, and the Navajo Reservation, research has shown that residential biomass combustion leads to elevated indoor levels of fine particulate matter (PM2.5) that often exceed current health- based air quality standards. Parallel findings have been observed in several developing countries where biomass combustion is commonly used for cooking and/or heating. This is concerning, as PM2.5 exposure is associated with many adverse health outcomes, including a greater than three-fold increased risk of LRTIs. Currently, there is a global effort to reduce indoor biomass smoke exposures in developing countries through the introduction of improved cookstove technology. Similar evidence-based efforts are warranted in rural and Native American communities in the US that suffer from elevated rates of childhood LRTI and commonly use wood for residential heating. To date, exposure reduction strategies in wood stove homes have been either inconsistently effective or include factors that limit widespread dissemination and continued compliance in rural and economically disadvantaged populations. This proposed project will focus on three unique and underserved study areas that have demonstrated associations between wood smoke exposure and LRTI among children. Within (1) rural mountain valley communities in western Montana, (2) Navajo Nation communities, and (3) Alaska Native communities, we will test the efficacy of two intervention strategies for reducing indoor wood smoke PM2.5 exposures and children's risk LRTI. We will conduct a three-arm randomized placebo-controlled post-only intervention trial in wood stove homes with children less than five years old. Education on best-burn practices and training on the use of simple instruments (i.e., stove thermometers and wood moisture meters) will be introduced as one intervention arm (Tx1). An indoor air filtration unit will be introduced as a second treatment arm (Tx2). Efficacy of each treatment arm in reducing indoor PM2.5 and child LRTI will be evaluated against a placebo arm (Tx3, sham air filters). Tx1 and Tx2 interventions will also be compared for sustainability. The primary outcome will be LRTI incidence among children under five years of age. To allow for detection of exposure and outcome differences within each of the three regions, a sample of 324 homes, or 108 within each study area will be equally assigned to each of the three intervention arms. We anticipate that 486 total children will participate in this proposed five year project. The overall hypothesis is that a low-cost, educational intervention targeting indoor wood smoke PM2.5 exposures will be sustainable, and can reduce children's risk of LRTI in underserved Native and rural communities.

描述（由申请人提供）：急性下呼吸道感染（LRTIs）占美国5岁以下儿童住院总数的27%以上，儿童复发性下呼吸道感染是公认的哮喘危险因素。在蒙大拿州、阿拉斯加州和纳瓦霍保留地的农村地区，研究表明，住宅生物质燃烧导致室内细颗粒物（PM2.5）水平升高，经常超过目前基于健康的空气质量标准。在生物质燃烧通常用于烹饪和（或）取暖的几个发展中国家也观察到类似的结果。这是令人担忧的，因为PM2.5暴露与许多不良健康结果有关，包括下呼吸道感染风险增加三倍以上。目前，全球都在努力