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,Environmental Health Perspectives

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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
Environmental Health Perspectives ( IF 10.1 ) Pub Date : 2022-5-12 , DOI: 10.1289/ehp10054
Magdalena Fandiño-Del-Rio _{1,

2} , Josiah L Kephart _{1,

2} , Kendra N Williams _{2,

3} , Timothy Shade ₂ , Temi Adekunle ₁ , Kyle Steenland ₄ , Luke P Naeher ₅ , Lawrence H Moulton ₆ , Gustavo F Gonzales _{7,

8} , Marilu Chiang ₉ , Shakir Hossen _{2,

3} , Ryan T Chartier ₁₀ , Kirsten Koehler ₁ , William Checkley _{2,

3,

6} ,

Affiliation

Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA.
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Environmental Health Science Department, College of Public Health, University of Georgia, Athens, Georgia, USA.
Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Laboratories of Investigation and Development, Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.
High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Perú.
Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Perú.
RTI International, Durham, North Carolina, USA.

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 $less than or equal to 2.5 micrometers$ ( $particulate matter begin subscript 2.5 end subscript$ ), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization.

Results:

Baseline $mean [\pm standard deviation (SD)]$ $particulate matter begin subscript 2.5 end subscript$ (kitchen area concentrations $1,220 \pm 1,010$ vs. $1,190 \pm 880 {μ g / m}^{3}$ ; personal exposure $126 \pm 214$ vs. $104 \pm 100 {μ g / m}^{3}$ ), CO (kitchen $53 \pm 49$ vs. $50 \pm 41 ppm$ ; personal $7 \pm 8$ vs. $7 \pm 8 ppm$ ), and BC (kitchen $180 \pm 120$ vs. $210 \pm 150 {μ g / m}^{3}$ ; personal $19 \pm 16$ vs. $21 \pm 22 {μ g / m}^{3}$ ) were similar between control and intervention participants. Intervention participants had consistently lower $mean (\pm SD)$ concentrations at the 12-month visit for kitchen ( $41 \pm 59 {μ g / m}^{3}$ , $3 \pm 6 {μ g / m}^{3}$ , and $8 \pm 13 ppm$ ) and personal exposures ( $26 \pm 34 {μ g / m}^{3}$ , $2 \pm 3 {μ g / m}^{3}$ , and $3 \pm 4 ppm$ ) to $particulate matter begin subscript 2.5 end subscript$ , 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 $particulate matter begin subscript 2.5 end subscript$ , BC, and CO kitchen mean concentrations of $34 \pm 74 {μ g / m}^{3}$ , $3 \pm 5 {μ g / m}^{3}$ , and $6 \pm 6 ppm$ and personal exposures of $17 \pm 15 {μ g / m}^{3}$ , $2 \pm 2 {μ g / m}^{3}$ , and $3 \pm 4 ppm$ , respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit $particulate matter begin subscript 2.5 end subscript$ , BC, and CO kitchen mean concentrations of $561 \pm 1,251 {μ g / m}^{3}$ , $82 \pm 124 {μ g / m}^{3}$ , and $23 \pm 28 ppm$ and personal exposures of $35 \pm 38 {μ g / m}^{3}$ , $6 \pm 6 {μ g / m}^{3}$ , and $4 \pm 5 ppm$ , 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. https://doi.org/10.1289/EHP10054

中文翻译：

秘鲁农村地区液化石油气干预后的家庭空气污染浓度：一年随机对照试验和一年实用交叉试验的结果

抽象的

背景：

生物质燃料燃烧造成的家庭空气污染 (HAP) 仍然是全球发病率的主要环境风险因素。

客观的：

测量秘鲁普诺液化石油气 (LPG) 干预措施对 HAP 暴露的影响。

方法：

我们对 180 名 25-64 岁的女性进行了一项为期 1 年的随机对照试验，随后又进行了一项为期 1 年的实用交叉试验。在第一年，干预参与者获得了免费的液化石油气炉、持续的燃料输送和定期的行为信息，而对照组则继续他们的生物质烹饪实践。在第二年，对照组参与者收到了一个免费的液化石油气炉、定期行为信息以及从附近经销商处获取液化石油气罐的代金券，而干预参与者则停止了燃料分配。我们收集了 48 小时厨房区域浓度和个人暴露于空气动力学直径的细颗粒物 (PM) 的情况 $\leq 2.5 μ 米$ （ ${下午}_{2.5}$ )、黑碳 (BC) 和一氧化碳 (CO) 在基线以及随机化后 3、6、12、18 和 24 个月。

结果：

基线 $意思是 [\pm 标准差（标清）]$ ${下午}_{2.5}$ （厨房区域集中度 $1,220 \pm 1,010$ 与 $1,190 人 \pm 880 {μ 克 / 米}^{3}$ ;个人曝光 $126 \pm 214$ 与 $104 \pm 100 {μ 克 / 米}^{3}$ ), CO (厨房 $53 \pm 49$ 与 $50 \pm 41 百万分之一$ ;个人的 $7 \pm 8$ 与 $7 \pm 8 百万分之一$ ）和 BC（厨房 $180 \pm 120$ 与 $210 \pm 150 {μ 克 / 米}^{3}$ ;个人的 $19 \pm 16$ 与 $21 \pm 22 {μ 克 / 米}^{3}$ ）在对照组和干预参与者之间是相似的。干预参与者的得分持续较低 $意思是（ \pm 标清）$ 12 个月访问厨房时的浓度（ $41 \pm 59 {μ 克 / 米}^{3}$ , $3 \pm 6 {μ 克 / 米}^{3}$ ，和 $8 \pm 13 百万分之一$ ）和个人暴露（ $26 \pm 34 {μ 克 / 米}^{3}$ , $2 \pm 3 {μ 克 / 米}^{3}$ ，和 $3 \pm 4 百万分之一$ ）到 ${下午}_{2.5}$ 、BC 和 CO 与第一年的对照相比。第二年，我们观察到在对液化石油气燃料实施基于凭证的干预措施后，对照组的 HAP 减少量相当（24 个月的访问） ${下午}_{2.5}$ 、BC 和 CO 厨房平均浓度 $34 \pm 74 {μ 克 / 米}^{3}$ , $3 \pm 5 {μ 克 / 米}^{3}$ ，和 $6 \pm 6 百万分之一$ 以及个人的曝光 $17 号 \pm 15 {μ 克 / 米}^{3}$ , $2 \pm 2 {μ 克 / 米}^{3}$ ，和 $3 \pm 4 百万分之一$ ，分别），即使在免费燃油分发停止后（24 个月访问 ${下午}_{2.5}$ 、BC 和 CO 厨房平均浓度 $第561章 \pm 1,251 {μ 克 / 米}^{3}$ , $82 \pm 124 {μ 克 / 米}^{3}$ ，和 $23 \pm 28 百万分之一$ 以及个人的曝光 $35 \pm 38 {μ 克 / 米}^{3}$ , $6 \pm 6 {μ 克 / 米}^{3}$ ，和 $4 \pm 5 百万分之一$ ，分别）。

讨论：

一年内送货上门和基于优惠券的免费液化石油气供应，再加上提供免费液化石油气炉和纵向行为信息，将 HAP 降低到低于世界卫生组织 24 小时空气质量指南的水平。此外，对 HAP 的干预措施在燃料供应停止后仍持续一年。此类策略可应用于液化石油气项目，以减少 HAP 并有可能改善健康。 https://doi.org/10.1289/EHP10054

更新日期：2022-05-13

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