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Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health
BACKGROUND: Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic he...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615088/ https://www.ncbi.nlm.nih.gov/pubmed/31286921 http://dx.doi.org/10.1186/s12889-019-7214-2 |
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author | Young, Bonnie N. Peel, Jennifer L. Benka-Coker, Megan L. Rajkumar, Sarah Walker, Ethan S. Brook, Robert D. Nelson, Tracy L. Volckens, John L’Orange, Christian Good, Nicholas Quinn, Casey Keller, Joshua P. Weller, Zachary D. Africano, Sebastian Osorto Pinel, Anibal B. Clark, Maggie L. |
author_facet | Young, Bonnie N. Peel, Jennifer L. Benka-Coker, Megan L. Rajkumar, Sarah Walker, Ethan S. Brook, Robert D. Nelson, Tracy L. Volckens, John L’Orange, Christian Good, Nicholas Quinn, Casey Keller, Joshua P. Weller, Zachary D. Africano, Sebastian Osorto Pinel, Anibal B. Clark, Maggie L. |
author_sort | Young, Bonnie N. |
collection | PubMed |
description | BACKGROUND: Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN: We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24–59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM(2.5)) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM(2.5) and indicators of cardiometabolic health. DISCUSSION: This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02658383, posted January 18, 2016, field work completed May 2018. Official title, “Community-Based Participatory Research: A Tool to Advance Cookstove Interventions.” Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-7214-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6615088 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66150882019-07-18 Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health Young, Bonnie N. Peel, Jennifer L. Benka-Coker, Megan L. Rajkumar, Sarah Walker, Ethan S. Brook, Robert D. Nelson, Tracy L. Volckens, John L’Orange, Christian Good, Nicholas Quinn, Casey Keller, Joshua P. Weller, Zachary D. Africano, Sebastian Osorto Pinel, Anibal B. Clark, Maggie L. BMC Public Health Study Protocol BACKGROUND: Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN: We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24–59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM(2.5)) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM(2.5) and indicators of cardiometabolic health. DISCUSSION: This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02658383, posted January 18, 2016, field work completed May 2018. Official title, “Community-Based Participatory Research: A Tool to Advance Cookstove Interventions.” Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-7214-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-08 /pmc/articles/PMC6615088/ /pubmed/31286921 http://dx.doi.org/10.1186/s12889-019-7214-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Study Protocol Young, Bonnie N. Peel, Jennifer L. Benka-Coker, Megan L. Rajkumar, Sarah Walker, Ethan S. Brook, Robert D. Nelson, Tracy L. Volckens, John L’Orange, Christian Good, Nicholas Quinn, Casey Keller, Joshua P. Weller, Zachary D. Africano, Sebastian Osorto Pinel, Anibal B. Clark, Maggie L. Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title | Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title_full | Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title_fullStr | Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title_full_unstemmed | Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title_short | Study protocol for a stepped-wedge randomized cookstove intervention in rural Honduras: household air pollution and cardiometabolic health |
title_sort | study protocol for a stepped-wedge randomized cookstove intervention in rural honduras: household air pollution and cardiometabolic health |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615088/ https://www.ncbi.nlm.nih.gov/pubmed/31286921 http://dx.doi.org/10.1186/s12889-019-7214-2 |
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