Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras

Megan L. Benka-Coker; Bonnie N. Young; Joshua P. Keller; Ethan S. Walker; Sarah Rajkumar; John Volckens; Nicholas Good; Casey Quinn; Christian L'Orange; Zachary D. Weller; Sebastian Africano; Anibal B. Osorto Pinel; Jennifer L. Peel; Maggie L. Clark

doi:10.1016/j.scitotenv.2020.144369

Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras

Megan L. Benka-Coker
, Bonnie N. Young
, Joshua P. Keller
, Ethan S. Walker
, Sarah Rajkumar
, John Volckens
, Nicholas Good
, Casey Quinn
, Christian L'Orange
, Zachary D. Weller
, Sebastian Africano
, Anibal B. Osorto Pinel
, Jennifer L. Peel
, Maggie L. Clark

School of Public and Community Health Sciences

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Trial design: We evaluated the impact of a biomass stove intervention on fine particulate matter (PM_2.5) concentrations using an individual-level, stepped-wedge randomized trial. Methods: We enrolled 230 women in rural Honduran households using traditional biomass stoves and randomly allocated them to one of two study arms. The Justa stove, the study intervention, was locally-sourced, wood-burning, and included an engineered combustion chamber and chimney. At each of 6 visits over 3 years, we measured 24-hour gravimetric personal and kitchen PM_2.5 concentrations. Half of the households received the intervention after Visit 2 and half after Visit 4. We conducted intent-to-treat analyses to evaluate the intervention effect using linear mixed models with log-transformed kitchen or personal PM_2.5 (separately) as the dependent variable, adjusting for time. We also compared PM_2.5 concentrations to World Health Organization (WHO) guidelines. Results: Arms 1 and 2 each had 115 participants with 664 and 632 completed visits, respectively. Median 24-hour average personal PM_2.5 exposures were 81 μg/m³ (25th–75th percentile: 50–141 μg/m³) for the traditional stove condition (n=622) and 43 μg/m³ (25th–75th percentile: 27–73 μg/m³) for the Justa stove condition (n=585). Median 24-hour average kitchen concentrations were 178 μg/m³ (25th–75th percentile: 69–440 μg/m³; n=629) and 53 μg/m³ (25th–75th percentile: 29–103 μg/m³; n=578) for the traditional and Justa stove conditions, respectively. The Justa intervention resulted in a 32% reduction in geometric mean personal PM_2.5 (95% confidence interval [CI]: 20–43%) and a 56% reduction (95% CI: 46–65%) in geometric mean kitchen PM_2.5. During rainy and dry seasons, 53% and 41% of participants with the Justa intervention had 24-hour average personal PM_2.5 exposures below the WHO interim target-3 guideline (37.5 μg/m³), respectively. Conclusion: The Justa stove intervention substantially lowered personal and kitchen PM_2.5 and may be a provisional solution that is feasible for Latin American communities where cleaner fuels may not be available, affordable, or acceptable for some time. Clinicaltrials.gov: NCT02658383.

Original language	English
Article number	144369
Journal	Science of the Total Environment
Volume	767
DOIs	https://doi.org/10.1016/j.scitotenv.2020.144369
State	Published - May 1 2021

Funding

We thank our community leaders from our advisory board, the participants, and our field team: Gloribel Bautista Cuellar, Socorro Perez, Guillermo Rivera, Mariel Vijil, Jonathan Stack, Quinn Olson, Annalise Wille, Rebecca Hermann, Laura Thompson, and Timothy Molnar. We are grateful for the collaboration with our colleagues at Trees, Water & People (Fort Collins, CO, USA) and AHDESA (Tegucigalpa, Honduras). Research was funded by the National Institute of Environmental Health Sciences of the National Institutes of Health under award number ES022269 (PI: Clark). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the study design. We thank our community leaders from our advisory board, the participants, and our field team: Gloribel Bautista Cuellar, Socorro Perez, Guillermo Rivera, Mariel Vijil, Jonathan Stack, Quinn Olson, Annalise Wille, Rebecca Hermann, Laura Thompson, and Timothy Molnar. We are grateful for the collaboration with our colleagues at Trees, Water & People (Fort Collins, CO, USA) and AHDESA (Tegucigalpa, Honduras). Research was funded by the National Institute of Environmental Health Sciences of the National Institutes of Health under award number ES022269 (PI: Clark). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the study design.

Funders	Funder number
AHDESA
R00ES022269

Keywords

Biomass cookstove
Exposure assessment
Household air pollution
Household energy
PM
Randomized controlled trial

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10.1016/j.scitotenv.2020.144369

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Benka-Coker, M. L., Young, B. N., Keller, J. P., Walker, E. S., Rajkumar, S., Volckens, J., Good, N., Quinn, C., L'Orange, C., Weller, Z. D., Africano, S., Osorto Pinel, A. B., Peel, J. L., & Clark, M. L. (2021). Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras. Science of the Total Environment, 767, Article 144369. https://doi.org/10.1016/j.scitotenv.2020.144369

@article{586c02d9b3b3411aac355d09b99c01fb,

title = "Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras",

abstract = "Trial design: We evaluated the impact of a biomass stove intervention on fine particulate matter (PM2.5) concentrations using an individual-level, stepped-wedge randomized trial. Methods: We enrolled 230 women in rural Honduran households using traditional biomass stoves and randomly allocated them to one of two study arms. The Justa stove, the study intervention, was locally-sourced, wood-burning, and included an engineered combustion chamber and chimney. At each of 6 visits over 3 years, we measured 24-hour gravimetric personal and kitchen PM2.5 concentrations. Half of the households received the intervention after Visit 2 and half after Visit 4. We conducted intent-to-treat analyses to evaluate the intervention effect using linear mixed models with log-transformed kitchen or personal PM2.5 (separately) as the dependent variable, adjusting for time. We also compared PM2.5 concentrations to World Health Organization (WHO) guidelines. Results: Arms 1 and 2 each had 115 participants with 664 and 632 completed visits, respectively. Median 24-hour average personal PM2.5 exposures were 81 μg/m3 (25th–75th percentile: 50–141 μg/m3) for the traditional stove condition (n=622) and 43 μg/m3 (25th–75th percentile: 27–73 μg/m3) for the Justa stove condition (n=585). Median 24-hour average kitchen concentrations were 178 μg/m3 (25th–75th percentile: 69–440 μg/m3; n=629) and 53 μg/m3 (25th–75th percentile: 29–103 μg/m3; n=578) for the traditional and Justa stove conditions, respectively. The Justa intervention resulted in a 32\% reduction in geometric mean personal PM2.5 (95\% confidence interval [CI]: 20–43\%) and a 56\% reduction (95\% CI: 46–65\%) in geometric mean kitchen PM2.5. During rainy and dry seasons, 53\% and 41\% of participants with the Justa intervention had 24-hour average personal PM2.5 exposures below the WHO interim target-3 guideline (37.5 μg/m3), respectively. Conclusion: The Justa stove intervention substantially lowered personal and kitchen PM2.5 and may be a provisional solution that is feasible for Latin American communities where cleaner fuels may not be available, affordable, or acceptable for some time. Clinicaltrials.gov: NCT02658383.",

keywords = "Biomass cookstove, Exposure assessment, Household air pollution, Household energy, PM, Randomized controlled trial",

author = "Benka-Coker, \{Megan L.\} and Young, \{Bonnie N.\} and Keller, \{Joshua P.\} and Walker, \{Ethan S.\} and Sarah Rajkumar and John Volckens and Nicholas Good and Casey Quinn and Christian L'Orange and Weller, \{Zachary D.\} and Sebastian Africano and \{Osorto Pinel\}, \{Anibal B.\} and Peel, \{Jennifer L.\} and Clark, \{Maggie L.\}",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier B.V.",

year = "2021",

month = may,

day = "1",

doi = "10.1016/j.scitotenv.2020.144369",

language = "English",

volume = "767",

journal = "Science of the Total Environment",

issn = "0048-9697",

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Benka-Coker, ML, Young, BN, Keller, JP, Walker, ES, Rajkumar, S, Volckens, J, Good, N, Quinn, C, L'Orange, C, Weller, ZD, Africano, S, Osorto Pinel, AB, Peel, JL & Clark, ML 2021, 'Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras', Science of the Total Environment, vol. 767, 144369. https://doi.org/10.1016/j.scitotenv.2020.144369

TY - JOUR

T1 - Impact of the wood-burning Justa cookstove on fine particulate matter exposure

T2 - A stepped-wedge randomized trial in rural Honduras

AU - Benka-Coker, Megan L.

AU - Young, Bonnie N.

AU - Keller, Joshua P.

AU - Walker, Ethan S.

AU - Rajkumar, Sarah

AU - Volckens, John

AU - Good, Nicholas

AU - Quinn, Casey

AU - L'Orange, Christian

AU - Weller, Zachary D.

AU - Africano, Sebastian

AU - Osorto Pinel, Anibal B.

AU - Peel, Jennifer L.

AU - Clark, Maggie L.

PY - 2021/5/1

Y1 - 2021/5/1

N2 - Trial design: We evaluated the impact of a biomass stove intervention on fine particulate matter (PM2.5) concentrations using an individual-level, stepped-wedge randomized trial. Methods: We enrolled 230 women in rural Honduran households using traditional biomass stoves and randomly allocated them to one of two study arms. The Justa stove, the study intervention, was locally-sourced, wood-burning, and included an engineered combustion chamber and chimney. At each of 6 visits over 3 years, we measured 24-hour gravimetric personal and kitchen PM2.5 concentrations. Half of the households received the intervention after Visit 2 and half after Visit 4. We conducted intent-to-treat analyses to evaluate the intervention effect using linear mixed models with log-transformed kitchen or personal PM2.5 (separately) as the dependent variable, adjusting for time. We also compared PM2.5 concentrations to World Health Organization (WHO) guidelines. Results: Arms 1 and 2 each had 115 participants with 664 and 632 completed visits, respectively. Median 24-hour average personal PM2.5 exposures were 81 μg/m3 (25th–75th percentile: 50–141 μg/m3) for the traditional stove condition (n=622) and 43 μg/m3 (25th–75th percentile: 27–73 μg/m3) for the Justa stove condition (n=585). Median 24-hour average kitchen concentrations were 178 μg/m3 (25th–75th percentile: 69–440 μg/m3; n=629) and 53 μg/m3 (25th–75th percentile: 29–103 μg/m3; n=578) for the traditional and Justa stove conditions, respectively. The Justa intervention resulted in a 32% reduction in geometric mean personal PM2.5 (95% confidence interval [CI]: 20–43%) and a 56% reduction (95% CI: 46–65%) in geometric mean kitchen PM2.5. During rainy and dry seasons, 53% and 41% of participants with the Justa intervention had 24-hour average personal PM2.5 exposures below the WHO interim target-3 guideline (37.5 μg/m3), respectively. Conclusion: The Justa stove intervention substantially lowered personal and kitchen PM2.5 and may be a provisional solution that is feasible for Latin American communities where cleaner fuels may not be available, affordable, or acceptable for some time. Clinicaltrials.gov: NCT02658383.

AB - Trial design: We evaluated the impact of a biomass stove intervention on fine particulate matter (PM2.5) concentrations using an individual-level, stepped-wedge randomized trial. Methods: We enrolled 230 women in rural Honduran households using traditional biomass stoves and randomly allocated them to one of two study arms. The Justa stove, the study intervention, was locally-sourced, wood-burning, and included an engineered combustion chamber and chimney. At each of 6 visits over 3 years, we measured 24-hour gravimetric personal and kitchen PM2.5 concentrations. Half of the households received the intervention after Visit 2 and half after Visit 4. We conducted intent-to-treat analyses to evaluate the intervention effect using linear mixed models with log-transformed kitchen or personal PM2.5 (separately) as the dependent variable, adjusting for time. We also compared PM2.5 concentrations to World Health Organization (WHO) guidelines. Results: Arms 1 and 2 each had 115 participants with 664 and 632 completed visits, respectively. Median 24-hour average personal PM2.5 exposures were 81 μg/m3 (25th–75th percentile: 50–141 μg/m3) for the traditional stove condition (n=622) and 43 μg/m3 (25th–75th percentile: 27–73 μg/m3) for the Justa stove condition (n=585). Median 24-hour average kitchen concentrations were 178 μg/m3 (25th–75th percentile: 69–440 μg/m3; n=629) and 53 μg/m3 (25th–75th percentile: 29–103 μg/m3; n=578) for the traditional and Justa stove conditions, respectively. The Justa intervention resulted in a 32% reduction in geometric mean personal PM2.5 (95% confidence interval [CI]: 20–43%) and a 56% reduction (95% CI: 46–65%) in geometric mean kitchen PM2.5. During rainy and dry seasons, 53% and 41% of participants with the Justa intervention had 24-hour average personal PM2.5 exposures below the WHO interim target-3 guideline (37.5 μg/m3), respectively. Conclusion: The Justa stove intervention substantially lowered personal and kitchen PM2.5 and may be a provisional solution that is feasible for Latin American communities where cleaner fuels may not be available, affordable, or acceptable for some time. Clinicaltrials.gov: NCT02658383.

KW - Biomass cookstove

KW - Exposure assessment

KW - Household air pollution

KW - Household energy

KW - PM

KW - Randomized controlled trial

UR - https://www.scopus.com/pages/publications/85098969946

U2 - 10.1016/j.scitotenv.2020.144369

DO - 10.1016/j.scitotenv.2020.144369

M3 - Article

C2 - 33429278

AN - SCOPUS:85098969946

SN - 0048-9697

VL - 767

JO - Science of the Total Environment

JF - Science of the Total Environment

M1 - 144369

ER -

Impact of the wood-burning Justa cookstove on fine particulate matter exposure: A stepped-wedge randomized trial in rural Honduras

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Keywords

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