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(申请人提供)：急性下呼吸道感染(LRTI)占美国5岁以下儿童住院总数的27%以上，儿童反复LRTI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护区的农村地区，研究表明，住宅生物质燃烧会导致室内细颗粒物(PM2.5)水平升高，往往超过当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了类似的结果。这令人担忧，因为PM2.5暴露与许多不利的健康后果有关，包括LRTI风险增加三倍以上。目前，全球正在努力 通过采用改进的炉灶技术，减少发展中国家的室内生物质烟雾暴露。类似的循证努力在美国农村和美国原住民社区也是必要的，这些社区患有儿童LRTI率高，通常使用木材作为住宅供暖。迄今为止，木炉之家的减少暴露战略要么效果不一致，要么包括限制广泛传播和在农村和经济上处于不利地位的人口继续遵守的因素。这个拟议的项目将侧重于三个独特的、服务不足的研究领域，这些领域已经证明了木烟暴露与儿童LRTI之间的联系。在(1)蒙大拿州西部的乡村山谷社区、(2)纳瓦霍民族社区和(3)阿拉斯加土著社区，我们将测试两种减少室内木烟PM2.5暴露和儿童LRTI风险的干预策略的有效性。我们将在有5岁以下儿童的木炉家庭中进行一项三组随机、安慰剂对照的仅限后干预试验。关于最佳焚烧做法的教育和关于使用简单仪器(即炉子温度计和木材湿度计)的培训将作为一个干预臂(TX1)推出。将引入一个室内空气过滤装置作为第二个处理臂(Tx2)。每个治疗组在减少室内PM2.5和儿童LRTI方面的效果将与安慰剂组(Tx3，假空气过滤器)进行比较。TX1和TX2干预也将在可持续性方面进行比较。主要结果将是5岁以下儿童的下呼吸道感染发病率。为了能够检测三个区域中每一个区域内的暴露情况和结果差异，将在每个研究区域内平均分配324个家庭或每个研究区域内的108个家庭的样本给三个干预部门。我们预计总共将有486名儿童参加这次活动 建议的五年计划。总体假设是，针对室内木烟PM2.5暴露的低成本教育干预将是可持续的，并可以在服务不足的土著和农村社区降低儿童感染LRTI的风险。