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

描述（由申请人提供）：本职业发展奖的目标是启动一个独立的空气污染流行病学研究项目，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。候选人将在社会和行为改变方法方面接受额外的培训，这对进一步开展炉灶研究领域至关重要，并将独特地提供必要的技能，以发展独立的研究事业，专注于开发这些新颖的干预研究方法。近30亿人依靠生物质燃烧来满足基本的家庭能源需求。许多家庭使用传统炉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。据估计，生物质燃烧产生的室内空气污染每年造成160万人过早死亡，约占全球疾病负担的3%。改进的炉灶设计有可能大大减少室内空气污染暴露。然而，很少有随机干预试验，并且先前的炉子干预研究一直受到炉子采用率和持续使用的低改进的困扰，严重限制了对这些研究的解释。本研究建议在洪都拉斯烹饪炉用户中进行社区调查和深度访谈，以深入了解围绕持续改进烹饪炉采用的障碍和预测因素的复杂途径（目标1，k99阶段，目标2-3中拟议干预的目标人群）。这些信息将用于在300个洪都拉斯家庭中开展和加强一项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和心血管健康亚临床指标的变化（目标2-3，r001阶段）。主要目标有两个：在研究的所有方面纳入基于社区的参与性研究（CBPR）方法，并最大限度地持续使用炉子（从而最大限度地提高干预对健康的影响），以实现有效的接触反应估计。这两个目标都利用创新策略来填补知识空白。候选人将得到一个在空气污染流行病学、暴露评估技术和基于社区的研究方法方面具有专业知识的指导和研究小组的广泛支持。该研究小组将以以前在拉丁美洲进行的研究为基础，这些研究的重点是确定和验证在发展中国家农村地区进行接触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炉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（树木，水和人，柯林斯堡，科罗拉多州；AHDESA，特古西加尔巴，洪都拉斯）密切合作，取得了成功。此外，还与洪都拉斯的学术合作伙伴（洪都拉斯特古西加尔瓦的萨莫拉诺大学）建立了新的关系，该大学与TWP和AHDESA建立了持续而富有成效的关系。这些合作伙伴将组成拟议的社区和学术咨询委员会，以进一步发展研究计划的方法和行为。总之，拟议的培训和研究计划是研究小组先前在拉丁美洲进行的炉灶研究的合乎逻辑的后续行动。它将提供关于持续使用炉灶的障碍/预测因素的见解，这是一个阻碍该领域研究的问题；评估炉灶使用与心血管健康指标之间的关系，心血管健康是发展中国家一个巨大且迅速增长的疾病负担；对炉灶干预的影响进行更全面有效的评估；并为候选人提供必要的工具，以发展一个充满活力的独立研究事业，通过进行研究整合物理和社会环境之间的动态关系，影响空气污染流行病学领域。

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.