Household Air Pollution Concentrations after Liquefied Petroleum Gas Interventions in Rural Peru: Findings from a One-Year Randomized Controlled Trial Followed by a One-Year Pragmatic Crossover Trial

• Type of Material: Article
• Authors: Magdalena Fandino-Del-Rio, Johns Hopkins University; Josiah L Kephart, Johns Hopkins University; Kendra N Williams, Johns Hopkins University; Timothy Shade, Johns Hopkins University; Temi Adekunle, Johns Hopkins University; Nelson Steenland, Emory University; Luke P Naeher, University of Georgia; Lawrence H Moulton, Johns Hopkins University; Gustavo F Gonzales, Universidad Peruana Cayetano Heredia; Marilu Chiang, Asociac Benef PRISMA; Shakir Hossen, Johns Hopkins University; Ryan T Chartier, RTI International; Kirsten Koehler, Johns Hopkins University; William Checkley, Johns Hopkins University
• Language: English
• Date: 2022-05-01
• Publisher: US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.
• Final Published Version (URL): http://dx.doi.org/10.1289/EHP10054
• Title of Journal or Parent Work: ENVIRONMENTAL HEALTH PERSPECTIVES
• Volume: 130
• Issue: 5
• Start Page: 57007
• End Page: 57007
• Grant/Funding Information: Research reported in this publication was supported by the U.S. National Institutes of Health (NIH) through the following Institutes and Centers: Fogarty International Center, National Institute of Environmental Health Sciences (NIEHS), National Cancer Institute, and Centers for Disease Control under award numbers U01TW010107 and U2RTW010114 [Multiple principal investigators (MPIs): W.C., G.F.G., L.P.N., K.S.]. This trial was additionally supported in part by the Clean Cooking Alliance of the United Nations Foundation UNF-16-810 [Principal investigator (PI): W.C.].; M.F. was further supported by the Global Environmental and Occupational Health (GEOHealth), Fogarty International Center, and by the David Leslie Swift Fund of the Bloomberg School of Public Health, JHU. K.N.W. and J.L.K. were supported by the NIH Research Training Grant D43TW009340 (MPIs: Buekens, W.C., Chi, Kondwani) funded by U.S. NIH through the following Institutes and Centers: Fogarty International Center; National Institute of Neurological Disorders and Stroke; National Institute of Mental Health; National Heart, Lung, and Blood Institute; and the NIEHS. J.L.K., K.N.W., and M.F. were supported by a Global Established Multidisciplinary Sites award from the Center for Global Health at JHU (PI: W.C.).; J.L.K. was further supported by the NIEHS of the NIH under award number T32ES007141 (PI: Wills-Karp). K.N.W. was supported by the National Heart, Lung, and Blood Institute of the NIH under award number T32HL007534 (PI: Wise). Our Global Non-Communicable Disease Research and Training field center in Puno, Peru, also received generous support from William and Bonnie Clarke III and the COPD Discovery Award from JHU.
• Keywords: EXPOSURES; Environmental Sciences & Ecology; Science & Technology; COOKSTOVES; Toxicology; MORTALITY; Life Sciences & Biomedicine; WOMEN; EMISSIONS; Environmental Sciences; OXIDATIVE STRESS; INDOOR; Public, Environmental & Occupational Health

Abstract

BACKGROUND: Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. OBJECTIVE: Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. METHODS: We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25–64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ≤2:5 lm (PM2:5), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. RESULTS: Baseline mean ½ ± standard deviation ðSDÞŠ PM2:5 (kitchen area concentrations 1,220 ± 1,010 vs. 1,190 ± 880 lg=m3; personal exposure 126 ± 214 vs. 104 ± 100 lg=m3), CO (kitchen 53 ± 49 vs. 50 ± 41 ppm; personal 7 ± 8 vs. 7 ± 8 ppm), and BC (kitchen 180 ± 120 vs. 210 ± 150 lg=m3; personal 19 ± 16 vs. 21 ± 22 lg=m3) were similar between control and intervention participants. Intervention participants had consistently lower mean ð ± SDÞ concentrations at the 12-month visit for kitchen (41 ± 59 lg=m3, 3 ± 6 lg=m3, and 8 ± 13 ppm) and personal exposures (26 ± 34 lg=m3, 2 ± 3 lg=m3, and 3 ± 4 ppm) to PM2:5, BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM2:5, BC, and CO kitchen mean concentrations of 34 ± 74 lg=m3, 3 ± 5 lg=m3, and 6 ± 6 ppm and personal exposures of 17 ± 15 lg=m3, 2 ± 2 lg=m3, and 3 ± 4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM2:5, BC, and CO kitchen mean concentrations of 561 ± 1,251 lg=m3, 82 ± 124 lg=m3, and 23 ± 28 ppm and personal exposures of 35 ± 38 lg=m3, 6 ± 6 lg=m3, and 4 ± 5 ppm, respectively). DISCUSSION: Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health.