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

该职业发展奖的目标是发起一项空气污染流行病学的独立研究计划，探索环境和社会/行为风险因素对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学方面接受额外的培训，这对于进一步推进炉灶研究领域至关重要，并将独特地提供发展独立研究职业所需的技能，专注于这些新方法的发展干预研究。近30亿人依靠生物质燃烧来满足基本的国内能源需求。许多家庭使用传统的炉灶来满足这些能源需求，这可能导致极高的室内空气污染浓度。生物质燃烧造成的室内空气污染估计每年造成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。然而，很少有随机干预试验，以前的炉灶干预研究一直受到低改进炉灶采用和持续使用的困扰，严重限制了这些研究的解释。本研究建议在哥伦比亚炉灶用户中进行社区调查和深入访谈，以深入了解持续改进炉灶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）。这一信息将用于在300个马达加斯加家庭中进行和加强随机改进炉灶干预，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，R 00阶段）。主要目标有两个：在研究的所有方面纳入以社区为基础的前瞻性研究（CBPR）方法，并最大限度地持续使用炉灶（从而最大限度地提高干预措施的健康影响），以实现有效的预防响应估计。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，该团队具有空气污染流行病学，暴露评估技术和基于社区的方法进行研究的专业知识。研究小组将在拉丁美洲以往研究的基础上再接再厉，这些研究的重点是确定和验证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跨部门炉灶研究的博士研究经验与拟议项目直接相关。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[TWP]，柯林斯堡，CO; AHDESA，特古西加尔帕，洪都拉斯）密切合作并取得成功。此外，还与洪都拉斯学术伙伴（洪都拉斯特古西加尔普阿的萨莫拉诺大学）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。这些合作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实施。总而言之，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理后续行动。它将提供关于持续采用炉灶的障碍/预测因素的见解，这是一个阻碍这一领域研究的问题;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和迅速增长的疾病负担;对炉灶干预措施的影响进行更全面和有效的评估;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生涯，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。 公共卫生相关性：约有30亿人依靠固体燃料燃烧来满足基本的国内能源需求。许多家庭使用效率低下和通风不良的室内炉灶来满足这些能源需求，导致室内空气污染水平极高，每年造成全世界约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.