Prenatal household air pollution exposure: gas stove and behavioral interventions

 描述(申请人提供)：世界上近一半的人口使用固体燃料做饭。在资源匮乏的国家，孕妇及其新生儿暴露在来自固体燃料烟雾的危险的高水平家庭空气污染中。2010年，家庭空气污染在全球造成约400万人死亡，其中10万人死于新生儿肺炎。这可能低估了全球的负担，因为它不包括产前暴露在家庭空气污染中以及与早产有关的因素。尽管世界各地都在尽最大努力开发清洁燃烧的固体燃料炉具，但很少有炉具能将家庭空气污染持续降低到保护健康所需的水平。只有电炉和煤气炉才有这种潜力，但在该地区，电炉不是一个可行的选择 获得可靠电力的途径有限。液化石油气(LPG)炉具在完全采用时可以极大地减少家庭空气污染，但在现实生活条件下，燃气炉的采用和持续使用水平尚不清楚。此外，还可能发生室外和室内烹饪火灾和烟草烟雾的其他暴露，为避免这些暴露而量身定做的干预措施尚未经过测试。我们建议评估引入燃气灶的可行性和可接受性，并使用基于社会认知理论的框架来补充两种提供行为干预的替代方法。在第一种方法中，30名孕妇将获得一个煤气灶，并将在小组课程中由同行教育人员教授如何安全使用煤气灶，以及如何减少接触其他空气污染源。在第二种方法中，另外30名孕妇将接受煤气炉和小组课程，但在这一阶段，同伴教育者将在课程结束后走访每个家庭，帮助妇女及其家人确定减少Ar污染的首要战略。通过使用核对表，同伴教育者将观察家庭成员是否坚持量身定做的策略，并为家庭提供持续的支持。我们将使用炉灶使用监测设备来评估燃气灶的摄取和持续使用，测量母亲在使用燃气灶前后的尿多环芳烃代谢物，并测量围产期和新生儿在后续行为变化干预措施中接触一氧化碳和颗粒物的情况。将对孕妇及其新生儿进行健康评估和家庭空气污染测量。新生儿将在48小时内接受早产评估，并在出生后第一个月每周接受肺炎评估。这将为一项更大规模的研究提供基础，该研究旨在通过传播清洁的煤气炉并辅之以行为干预来降低婴儿的发病率和死亡率。

 DESCRIPTION (provided by applicant): Almost half of the world's population uses solid fuels for cooking. In low-resource countries, pregnant women and their neonates are exposed to dangerously high levels of household air pollution from solid fuel smoke. In 2010, household air pollution caused an estimated 4 million deaths globally, including 100,000 from neonatal pneumonia. This is likely an underestimate of global burden because it does not include prenatal exposures to household air pollution and association with preterm birth. Despite best efforts around the world to develop clean-burning solid fuel stoves, very few stoves have consistently reduced household air pollution to levels that are needed to protect health. Only electric and gas stoves have that potential, but electric stoves are not a viable option in regions with limited access to reliable electrical power. Liquid petroleum gas (LPG) stoves can dramatically reduce household air pollution when fully adopted, however, the level of adoption and sustained use of gas stoves under real-life conditions is unknown. Furthermore, other exposures to outdoor and indoor cooking fires and tobacco smoke may occur, and tailored interventions to avoid these exposures have not been tested. We propose to assess the feasibility and acceptability of an introduced gas stove complemented by two alternative approaches to delivering a behavioral intervention using a Social Cognitive Theory-based framework. In the first approach, 30 pregnant women will receive a gas stove and will be taught by peer educators in group classes how to safely use gas stoves and how to reduce exposure to other sources of air pollution. In the second approach, 30 additional pregnant women will receive the gas stove and group classes, but in this phase, peer educators will visit each home after the classes to help the women and their families identify top priority strategies to reduce ar pollution. Using a checklist, peer educators will observe whether household members adhere to tailored strategies and provide ongoing support to families. We will use stove use monitoring devices to assess gas stove uptake and sustained use, measure maternal urinary metabolites of polycyclic aromatic hydrocarbons before and after gas stove introduction and measure perinatal and neonatal exposures to carbon monoxide and particulate matter during the successive behavioral change interventions. Health assessments and household air pollution measurements will be conducted on pregnant women and their neonates. Neonates will be assessed for preterm birth at 48 hours and for pneumonia weekly during the first month of life. This will provide a foundation for a larger study aimed at reducing infant morbidity and mortality through the dissemination of a clean gas stove, complemented by a behavioral intervention.