EXPLORING RESPIRATORY HEALTH OUTCOMES FROM SUSTAINED USE OF EFFICIENT COOKSTOVES

描述（由申请人提供）：每年有近200万人死于固体生物质燃烧造成的室内空气污染，其中99%的死亡发生在发展中国家。生物质燃烧是急性呼吸道感染和慢性阻塞性肺病的主要危险因素，特别是在妇女和儿童中。仅在印度，固体生物质的低效燃烧每年就导致40万人过早死亡。研究表明，生物质燃烧是比吸烟更大的COPD风险因素，特别是在印度，1.56亿家庭仍然依赖固体生物质做饭和取暖。清洁-高效率和低排放-炉灶为这一公共卫生挑战提供了一个解决方案，但它们的采用和长期使用令人失望。虽然可以在实验室中生产出更高效、更减排的炉灶，但事实证明，设计这些炉灶以满足各种社会、经济、文化和社区背景下的用户需求具有挑战性。我们的R21试点研究将促进随后的RO 1提案，重点是农村家庭持续有效地使用清洁炉灶，其对室内真实的排放的影响，以及由此对农村妇女和儿童呼吸健康的影响。在这项试点中，我们将实施一项为期两年的随机分组试验，以评估促进和阻碍持续使用清洁炉灶技术的因素。这项研究将比较传统的烧柴炉灶（对照条件）和改良的烧柴炉灶对妇女和儿童呼吸系统健康的影响。我们将在印度安得拉邦和拉贾斯坦邦的120个家庭中实施这项研究。我们的研究人员团队来自医学，生物统计学，工程学和社会科学，具有强大的跨学科方法来研究改善炉灶使用的障碍，并在印度农村地区进行研究的丰富经验。R21的具体目标是：1）评估印度农村贫困人口持续使用清洁炉灶技术的因素，以便我们能够制定更精细的关键干预措施，重点是改善呼吸系统健康。2)生成效应量数据，以确定可行性并告知关键试验的样本量，该试验的主要目标是持续改善印度农村妇女和儿童的呼吸健康（通过FEV 1测量）。3)生成清洁炉灶技术的初步排放数据（颗粒物-质量和表面积、一氧化碳、硫氧化物）及其对呼吸健康结果的影响，这将有助于制定关键的清洁炉灶干预措施。在实现这些目标的过程中，我们将获得必要的初步数据，以进行更大规模的RO 1干预，以检查持续使用清洁炉灶的效果以及印度农村室内空气污染减少对妇女和儿童呼吸健康的影响。我们的学习和研究计划与NIEHS和全球清洁炉灶联盟的使命保持一致，即通过在全球范围内有效使用清洁高效的炉灶技术来解决妇女和儿童的健康问题。 公共卫生相关性：我们的研究是对解决世界各地数百万人的呼吸健康问题的直接回应，这些人燃烧固体生物质作为烹饪和取暖的主要燃料来源。NIH全球清洁炉灶联盟致力于减少慢性阻塞性肺病（COPD），并防止190万儿童因生物质燃烧而过早死亡。目前的提案将促进印度农村家庭使用更清洁的炉灶，从而大大改善健康和环境效益。

DESCRIPTION (provided by applicant): Nearly 2 million people die annually due to indoor air pollution from solid biomass combustion and 99 percent of these deaths are in developing countries. Biomass combustion is a leading risk factor in acute respiratory infections (ARI) and Chronic Obstructive Pulmonary Disease (COPD), especially among women and children. Inefficient combustion of solid biomass leads to 400,000 annual premature deaths in India alone. Studies suggest that biomass combustion is an even greater risk factor for COPD than smoking, particularly in India where 156 million households still depend on solid biomass for cooking and heating. Clean - high efficiency and low emissions - cookstoves offer a solution to this public health challenge, but their uptake and prolonged use have been disappointing. Although more efficient and emissions-reducing stoves can be produced in the laboratory, designing them to meet the needs of users in various social, economic, cultural, and community contexts has proved challenging. Our pilot R21 study will facilitate a subsequent RO1 proposal focused on sustained and effective use of clean cookstoves by rural households, their effect on real time indoor emissions, and on resulting changes in the respiratory health of rural women and children. In this pilot, we will implement a two-year cluster-randomized trial to evaluate factors that enable and hinder sustained use of clean cookstove technologies. The study will compare the effect of traditional wood burning stoves (the control condition) to that of improved wood burning stoves on the respiratory health of women and children. We will implement this study in 120 households in Andhra Pradesh and Rajasthan, India. Our team of investigators comes from medicine, biostatistics, engineering, and social science with a strong transdisciplinary approach to examining barriers to improved cookstove use and with substantial experience doing research in rural India. The specific aims of this R21 are: 1) Evaluate factors which enable and hinder sustained use of clean cookstove technologies by the rural poor in India so we can develop a more refined pivotal intervention focused on improving respiratory health. 2) To generate effect size data that establish the feasibility and inform the sample size o a pivotal trial whose primary objective will be sustained improvements in the respiratory health (measured by FEV1) of women and children in rural India. 3) To generate preliminary emissions data (particulate matter - mass and surface area based, CO, SOX) from clean cookstove technology and its effect on respiratory health outcomes that will facilitate the development of a pivotal clean cookstove intervention. In achieving these aims, we will then have necessary preliminary data to proceed with a larger scale RO1 intervention to examine the effect of sustained use of clean cookstoves and respiratory health outcomes in women and children due to reduced indoor air pollution in rural India. Our study and research program are aligned with the NIEHS and Global Alliance for Clean Cookstoves' mission to address the health of women and children through effective use of clean and efficient cookstove technologies worldwide. PUBLIC HEALTH RELEVANCE: Our study is a direct response to address respiratory health of millions around the world who combust solid biomass as their primary source of fuel for cooking and heating. The NIH Global Alliance for Clean Cookstoves seeks to reduce Chronic Obstructive Pulmonary Disease (COPD) and prevent the premature deaths of 1.9 million children due to biomass combustion. The current proposal will facilitate the use of cleaner cookstoves in rural Indian households resulting in significant improved health and environmental benefits.