Community-based Participatory Research: A Tool to Advance Cookstove Interventions

描述(申请人提供)：该职业发展奖的目标是发起一项独立的空气污染流行病学研究计划，探索环境和社会/行为风险因素与心血管疾病之间的动态关系。应聘者将接受社会和行为变化方法论方面的额外培训，这将是进一步推进厨灶研究领域的关键，并将独特地提供必要的技能，以发展专注于开发这些干预研究的新方法的独立研究生涯。近30亿人依靠生物质燃烧来满足基本的家庭能源需求。许多家庭使用传统的厨灶来满足这些能源需求，这可能导致室内空气污染浓度极高。生物质燃烧造成的室内空气污染估计每年导致160万人过早死亡，约占全球疾病负担的3%。改进的炉子设计有可能大幅减少室内空气污染暴露。然而，很少有随机干预试验，以前的炉子干预研究一直受到改进炉子采用率和持续使用较低的困扰，严重限制了对这些研究的解释。这项研究建议对洪都拉斯灶具使用者进行社区调查和深入访谈，以深入了解阻碍灶具持续改进采用的障碍和预测因素(目标1，K99阶段，在拟议干预目标2-3的目标人群中)。这些信息将用于在300个洪都拉斯家庭中进行和加强随机改进的炉灶干预，纳入炉灶使用的定性和定量措施，并测量干预前后污染物暴露的变化和心血管健康的亚临床指标(目标2-3，R00阶段)。主要目标有两个：将基于社区的参与研究(CBPR)方法纳入研究的所有方面，并最大限度地持续使用炉子(从而最大限度地提高干预措施的健康影响)，以实现有效的暴露-反应估计。这两个目标都利用创新战略来填补知识空白。候选人将得到指导和研究团队的广泛支持，该团队拥有空气污染流行病学、暴露评估技术和基于社区的研究方法方面的专业知识。研究小组将以拉丁美洲以前的研究为基础，这些研究的重点是确定和验证发展中国家农村地区暴露和健康评估的适当实地技术。候选人在尼加拉瓜进行多年炉灶干预的博士后研究和在洪都拉斯进行横断面厨灶研究的博士研究经验与拟议的项目直接相关。在过去的8年里，候选人和指导团队与社区合作伙伴(科罗拉多州柯林斯堡的Trees，Water&People[TWP]；洪都拉斯特古西加尔巴的AHDESA)进行了密切而成功的合作。此外，与洪都拉斯的学术伙伴(洪都拉斯特古西加尔普阿的Zamorano大学)建立了新的关系，后者与TWP和AHDESA保持着持续和富有成效的关系。这些伙伴将组成拟议的社区和学术咨询委员会，以进一步制定研究计划的方法和进行。总之，拟议的培训和研究计划是研究小组以前在拉丁美洲进行的炉灶研究的合乎逻辑的后续行动。它将深入了解炉灶持续采用的障碍/预测因素，这是阻碍该领域研究的一个问题；评估炉灶使用与心血管健康指标之间的关系，心血管健康指标是发展中国家日益严重的疾病负担；对炉灶干预措施的影响进行更全面和有效的评估；为候选人提供必要的工具，以发展充满活力的独立研究事业，通过开展综合自然环境和社会环境之间的动态关系的研究，影响空气污染流行病学领域。 公共卫生相关性：大约30亿人依赖固体燃料燃烧来满足基本的家庭能源需求。许多家庭使用低效和通风不良的室内厨灶来满足这些能源需求，导致室内空气污染水平极高，全球每年约有160万人过早死亡。拟议的工作将在以社区为基础的参与性研究框架内进行，并将审查改进的室内炉灶干预措施对发展中国家暴露和心血管健康变化的影响，同时采用各种方法促进对新炉灶的采用和持续使用。

DESCRIPTION (provided by applicant): The goal of this Career Development Award is to initiate an independent research program in air pollution epidemiology, exploring the dynamic relationship between environmental and social/behavioral risk factors on cardiovascular disease. The additional training the candidate will receive in social and behavior change methodologies will be essential for furthering the field of cook stove research and will uniquely provide the skills necessary to develop an independent research career focused on the development of these novel approaches to intervention research. Nearly 3 billion people rely on biomass combustion to meet basic domestic energy needs. Many households use traditional cook stoves to meet these energy needs, which can result in extremely high indoor air pollution concentrations. Indoor air pollution from biomass combustion accounts for an estimated 1.6 million premature deaths per year, representing about 3% of the global disease burden. Improved stove designs have the potential to substantially reduce indoor air pollution exposures. However, there are few randomized intervention trials, and previous stove intervention studies have been plagued by low improved stove adoption and sustained use, severely limiting interpretations of these studies. This research proposes to conduct community surveys and in-depth interviews among Honduran cook stove users to gain insight into the complex pathways surrounding barriers to and predictors of sustained improved cook stove adoption (Aim 1, K99-phase, among the target population for the proposed intervention in Aims 2-3). This information will be used to conduct and enhance a randomized improved cook stove intervention among 300 Honduran families, incorporating qualitative and quantitative measures of cook stove use and measuring pre- to post-intervention changes in pollutant exposures and subclinical indicators of cardiovascular health (Aims 2-3, R00-phase). The primary goals are twofold: to incorporate Community-Based Participatory Research (CBPR) approaches throughout all aspects of the research and to maximize sustained stove use (thereby maximizing the health impact of the intervention) to achieve valid exposure-response estimates. Both objectives utilize innovative strategies to fill knowledge gaps. The candidate will have the extensive support of a mentoring and research team with expertise in air pollution epidemiology, exposure assessment techniques, and community based approaches to conduct research. The research team will build upon previous studies in Latin America that have focused on identifying and validating appropriate field techniques for exposure and health assessments in rural areas of developing countries. The candidate's post-doctoral research conducting a multiyear stove intervention in Nicaragua and doctoral research experience conducting a cross-sectional cook stove study in Honduras is directly relevant to the proposed project. Over the past 8 years, the candidate and mentoring team have worked closely and successfully with the community partners (Trees, Water & People [TWP], Fort Collins, CO; AHDESA, Tegucigalpa, Honduras). Additionally, a new relationship with the Honduran academic partner (Zamorano University, Tegucigalpua, Honduras), who has an ongoing and productive relationship with TWP and AHDESA, has been cultivated. These partners will form the proposed Community and Academic Advisory Board to further develop the methods and conduct of the research plan. In summary, the proposed training and research plan is a logical follow-up to the research teams' previous cook stove studies conducted in Latin America. It will provide insight regarding barriers/predictors of sustained cook stove adoption, an issue impeding research in this field; assess the relationship between stove use and indicators of cardiovascular health, a substantial and quickly growing disease burden in developing countries; result in a more comprehensive and valid assessment of the impact of a cook stove intervention; and provide the candidate with the tools necessary to develop a vibrant independent research career, impacting the field of air pollution epidemiology by conducting research integrating the dynamic relationship between the physical and the social environment. Public Health Relevance: Approximately 3 billion people rely on solid fuel combustion to meet basic domestic energy needs. Many households use inefficient and poorly vented indoor cook stoves to meet these energy needs, leading to extremely high indoor air pollution levels and accounting for approximately 1.6 million premature deaths each year worldwide. The proposed work will be conducted within the framework of community-based participatory research and will examine the impact of an improved indoor cook stove intervention on changes in exposure and cardiovascular health in a developing country while employing methods to enhance adoption and sustained use of the new stove.