Exposure to household air pollution from biomass-burning cookstoves and HbA1c and diabetic status among Honduran women

Rajkumar, Sarah; Clark, Maggie L.; Young, Bonnie N.; Benka-Coker, Megan L.; Bachand, Annette M.; Brook, Robert D.; Nelson, Tracy L.; Volckens, John; Reynolds, S.; L’Orange, Christian; Good, Nicholas; Koehler, Kirsten; Africano, Sebastian; Pinel, Anibal B. Osorto; Peel, Jennifer L.

doi:10.1111/ina.12484

Cited by 38 publications

(27 citation statements)

References 41 publications

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“…The Mimi-Moto stove in Rwanda, for example, had PM 2.5 and CO emissions performance at up to ISO Tier 4 levels in homes [27]. We also did not report on stoves from Latin America or chimney stoves, which can substantially reduce exposure to household air pollution [52][53][54]. Especially useful would be a field study of fugitive emissions under real-world conditions, which would complement similar laboratory efforts [55], and provide context for how well chimney stoves capture and vent health damaging pollutants in homes.…”

Section: Limitations and Conclusionmentioning

confidence: 99%

In-Home Emissions Performance of Cookstoves in Asia and Africa

et al. 2019

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This paper presents results from eight field studies in Asia and Africa on the emissions performance of 16 stove/fuel combinations measured during normal cooking events in homes. Characterizing real-world emissions performance is important for understanding the climate and health implications of technologies being promoted as alternatives to displace baseline cooking stoves and fuels. Almost all of the stove interventions were measured to have substantial reductions in PM2.5 and CO emissions compared to their respective baseline technologies (reductions of 24–87% and 25–80%, for PM2.5 and CO emission rates, respectively), though comparison with performance guidance from the World Health Organization (WHO) and the International Organization for Standardization (ISO) suggests that further improvement for biomass stoves would help realize more health benefits. The emissions of LPG stoves were generally below the WHO interim PM2.5 emissions target (1.75 mg/min) though it was not clear how close they were to the most aspirational ISO (0.2 mg/min) or WHO (0.23 mg/min) targets as our limit of detection was 1.1 mg/min. Elemental and organic carbon emission factors and elemental-to-total carbon ratios (medians ranging from 0.11 to 0.42) were in line with previously reported field-based estimates for similar stove/fuel combinations. Two of the better performing forced draft stoves used with pellets—the Oorja (median ET/TC = 0.12) and Eco-Chula (median ET/TC = 0.42)—were at opposite ends of the range, indicating that important differences in combustion conditions can arise even between similar stove/fuel combinations. Field-based tests of stove performance also provide important feedback for laboratory test protocols. Comparison of these results to previously published water boiling test data from the laboratory reinforce the trend that stove performance is generally better during controlled laboratory conditions, with modified combustion efficiency (MCE) being consistently lower in the field for respective stove/fuel categories. New testing approaches, which operate stoves through a broader range of conditions, indicate potential for better MCE agreement than previous versions of water boiling tests. This improved agreement suggests that stove performance estimates from a new ISO laboratory testing protocol, including testing stoves across low, medium, and high firepower, may provide more representative estimates of real-world performance than previously used tests. More representative results from standardized laboratory testing should help push stove designs toward better real-world performance as well as provide a better indication of how the tested technologies will perform for the user.

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Section: Limitations and Conclusionmentioning

confidence: 99%

In-Home Emissions Performance of Cookstoves in Asia and Africa

et al. 2019

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“…We believe that immediately sharing some results is of value to the participants and will help keep them engaged in the study. Our previous results among Honduran primary cooks (n = 142) utilized the same point-of-care device to measure HbA1c; when HbA1c cut points were used to define diabetes risk, we observed evidence supporting an association between HAP and prevalent prediabetes/diabetes, for example, the prevalence ratio per interquartile range increase (84 lg=m 3 ) for 24-h personal PM 2:5 was 1.49 (95% CI: 1.11, 2.01) (Rajkumar et al 2018). Suggestive evidence of a positive association between PM 2:5 and continuously assessed HbA1c was also observed, particularly among women >49 years of age (Rajkumar et al 2018).…”

Section: Clinical Biomarkers In Dbsmentioning

confidence: 76%

Design and Rationale of the Biomarker Center of the Household Air Pollution Intervention Network (HAPIN) Trial

Barr

Puttaswamy

Jaacks

et al. 2020

Environ Health Perspect

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BACKGROUND: Biomarkers of exposure, susceptibility, and effect are fundamental for understanding environmental exposures, mechanistic pathways of effect, and monitoring early adverse outcomes. To date, no study has comprehensively evaluated a large suite and variety of biomarkers in household air pollution (HAP) studies in concert with exposure and outcome data. The Household Air Pollution Intervention Network (HAPIN) trial is a liquified petroleum gas (LPG) fuel/stove randomized intervention trial enrolling 800 pregnant women in each of four countries (i.e., Peru, Guatemala, Rwanda, and India). Their offspring will be followed from birth through 12 months of age to evaluate the role of pre-and postnatal exposure to HAP from biomass burning cookstoves in the control arm and LPG stoves in the intervention arm on growth and respiratory outcomes. In addition, up to 200 older adult women per site are being recruited in the same households to evaluate indicators of cardiopulmonary, metabolic, and cancer outcomes. OBJECTIVES: Here we describe the rationale and ultimate design of a comprehensive biomarker plan to enable us to explore more fully how exposure is related to disease outcome. METHODS: HAPIN enrollment and data collection began in May 2018 and will continue through August 2021. As a part of data collection, dried blood spot (DBS) and urine samples are being collected three times during pregnancy in pregnant women and older adult women. DBS are collected at birth for the child. DBS and urine samples are being collected from the older adult women and children three times throughout the child's first year of life. Exposure biomarkers that will be longitudinally measured in all participants include urinary hydroxy-polycyclic aromatic hydrocarbons, volatile organic chemical metabolites, metals/metalloids, levoglucosan, and cotinine. Biomarkers of effect, including inflammation, endothelial and oxidative stress biomarkers, lung cancer markers, and other clinically relevant measures will be analyzed in urine, DBS, or blood products from the older adult women. Similarly, genomic/epigenetic markers, microbiome, and metabolomics will be measured in older adult women samples. DISCUSSION: Our study design will yield a wealth of biomarker data to evaluate, in great detail, the link between exposures and health outcomes. In addition, our design is comprehensive and innovative by including cutting-edge measures such as metabolomics and epigenetics.

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“…There were no values above 300 ppb. Additional health outcomes, including blood pressure and diabetes, were evaluated in our study population and published elsewhere [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women

Benka-Coker

Clark

Rajkumar

et al. 2018

IJERPH

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Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO).

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Exposure to household air pollution from biomass-burning cookstoves and HbA1c and diabetic status among Honduran women

Cited by 38 publications

References 41 publications

In-Home Emissions Performance of Cookstoves in Asia and Africa

In-Home Emissions Performance of Cookstoves in Asia and Africa

Design and Rationale of the Biomarker Center of the Household Air Pollution Intervention Network (HAPIN) Trial

Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women

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