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 (PM2.5) 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 PM2.5 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.

译文

摘要背景:越来越多的证据表明,从燃烧生物质的炉灶暴露的家庭空气污染与心脏代谢疾病的风险有关。很少有炊具(生物质或其他生物)的随机对照干预措施能够定量地描述暴露量的变化和心脏代谢健康指标,这是低收入和中等收入国家(LMIC)日益增加且研究不足的负担。理想的解决方案是使家庭过渡到清洁的烹饪方式,例如使用电或液化石油气炉灶。但是,那些无力负担或无法获得这些选择的人将在可预见的未来继续燃烧生物质。诸如Justa(结合工程燃烧区和烟囱)的燃木灶具设计具有显着减少空气污染暴露的潜力。以前的炉灶干预研究受到炉灶类型的限制,而炉灶类型并未显着减少暴露量和/或受炉灶的采用和持续使用率低,很少有研究采用社区参与的方法来增强干预措施。
方法/设计:我们在洪都拉斯农村地区进行了Justa Cookstove干预的个体水平,楔入式随机对照试验。我们招募了230名未怀孕,不吸烟,年龄为24-59岁的女性初级厨师,他们在基线时使用传统的燃木炊具。社区顾问委员会指导调查的发展和与参与者的沟通,包括招募和保留策略。在为期3年的研究期内,参与者完成了6次研究访问,相隔约6个月。一半的妇女在探访2和探访4之后都接受了Justa。在每次探访中,我们测量了24小时体重个人和厨房细颗粒物(PM2.5)的浓度,定性和定量炊具的使用和采用指标以及指标代谢健康。主要的健康终点是血压,C反应蛋白和糖化血红蛋白。总体研究目标是探索采用和持续使用新灶具的障碍和促成因素,按分配的灶具类型比较健康终点,并探讨PM2.5与心脏代谢健康指标之间的暴露-反应关联。
讨论:该试验利用经济可行,社区审查的炉灶并评估与LMIC发病率和死亡率的主要原因相关的终点,将为全球家庭空气污染利益相关者提供重要信息。
试验注册:ClinicalTrials.gov标识符NCT02658383,于2016年1月18日发布,现场工作于2018年5月完成。官方标题为“基于社区的参与性研究:推进Cookstove干预的工具”。首席研究员玛吉·克拉克(Maggie L. Clark)博士最新更新发布于2018年7月12日。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录