Woodsmoke exposure and novel health indicators: a feasibility field study

描述（由申请人提供）： 全球近30亿人依靠固体燃料燃烧来满足基本的国内能源需求。大多数这种燃烧通常发生在最贫穷的人口中，使用的是燃烧生物质（木材、动物粪便、作物残渣）和煤的效率低、通风不良的室内炉灶，造成室内空气污染浓度极高。改进的、更节省燃料和燃烧更清洁的炉灶设计有可能大大减少室内空气污染。然而，对改进炉灶暴露和健康影响的定量评估有限。生物质和煤炭燃烧造成的室内空气污染估计每年导致全球160万人过早死亡，约占全球疾病负担的3%。这些估计数主要是根据对呼吸系统的影响。为了捕捉疾病的全部负担（和潜在的好处），炉灶研究将需要纳入更广泛的健康终点，利用在农村实地环境和医疗基础设施往往有限的国家可行的方法。此外，以前的研究，如果他们已经纳入定量污染测量-主要测量细颗粒物（PM2.5）和一氧化碳（CO）;更详细的定量暴露评估是必要的，以告知炉灶设计和优先事项。在这里，我们提出了一个横断面研究，结合创新的方法来衡量亚临床标志物的心肺和代谢健康以及密集的暴露评估。我们的中心假设是，与传统明火炉灶的用户相比，使用改进的、清洁燃烧的炉灶的用户将体验到更好的健康状况。 我们提出了以下具体目标：1）在由当前传统的明火使用者和清洁燃烧的炉灶使用者组成的人群中进行新的暴露和健康测量; 2）评估炉灶使用（传统与清洁燃烧的炉灶）与测量的室内和个人污染之间的横截面关联，以及心血管和代谢健康指标。在全球推广高效、清洁燃烧的炉灶有可能大大改善人类健康和环境。这似乎是一个简单的解决方案。然而，一个关键的差距仍然是，全面评估暴露和健康影响仍然是必要的，以鼓励和证明大规模的炉灶干预方案。该项目结合了新的健康和暴露措施，并确定了这些措施在实地环境中的可行性，将有助于我们了解生物质燃烧的影响，并提供初步证据支持更大规模随机试验的发展，从而使我们能够利用其影响进行未来的研究。鉴于世界各地普遍存在室内生物质烟雾暴露，以及这些慢性疾病在发展中国家日益普遍，需要进一步评价改良炉灶的影响，以充分评估这种暴露的负担。

DESCRIPTION (provided by applicant): Nearly three billion people worldwide rely on solid fuel combustion to meet basic domestic energy needs. Most of this combustion, typically found among the poorest populations, takes place using inefficient and poorly vented indoor cookstoves burning biomass (wood, animal dung, crop residues) and coal, resulting in extremely high indoor air pollution concentrations. Improved, more fuel efficient and cleaner-burning, stove designs have the potential to substantially reduce indoor air pollution exposures. However, quantitative assessments of improved stove exposure and health impacts are limited. Indoor air pollution from biomass and coal combustion accounts for an estimated 1.6 million premature deaths per year worldwide, representing about 3% of the global disease burden. These estimates are based primarily on respiratory effects. In order to capture the full burden of disease (and potential benefit), cookstove research will need to incorporate a broader range of health endpoints utilizing methods that are feasible in a rural field setting and in countries with often limited healthcare infrastructure. Furthermore, previous studies, if they have incorporated quantitative pollution measurements at all - have primarily measured fine particulate matter (PM2.5) and carbon monoxide (CO); more detailed quantitative exposure assessment is necessary to inform stove design and priorities. Here we propose a cross-sectional study incorporating innovative methods to measure subclinical markers of cardiopulmonary and metabolic health as well as intensive exposure assessment. Our central hypothesis is that users of improved, cleaner burning stoves will experience better health status compared to users of traditional open-fire cookstoves. We propose the following specific aims: 1) Conduct novel exposure and health measurements in a population consisting of current traditional, open fire users and cleaner-burning stove users and 2) Evaluate the cross-sectional association between stove use (traditional vs. cleaner-burning stoves) and measured indoor and personal pollution with indicators of cardiovascular and metabolic health. Global dissemination of efficient, cleaner-burning stoves has the potential to dramatically improve the health of humans and the environment. This might appear to be a straightforward solution. However, a critical gap remains in that comprehensive evaluations of exposures and health impacts are still necessary to encourage and justify large-scale stove intervention programs. This project, incorporating novel health and exposure measures and establishing the feasibility of these measures in field settings, will contribute to our knowledge f the impacts of biomass combustion and provide preliminary evidence to support the development of larger- scale randomized trials, thereby enabling us to leverage its impact for future studies. Given the ubiquity of indoor biomass smoke exposures around the world and the increasing prevalence of these chronic diseases in developing countries, further evaluation of the impact of improved stoves is needed in order to fully assess the burden of this exposure.