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. 2013 Oct;121(10):1120-8.
doi: 10.1289/ehp.1206429. Epub 2013 Jul 19.

Health and household air pollution from solid fuel use: the need for improved exposure assessment

Maggie L Clark  1 , Jennifer L Peel, Kalpana Balakrishnan, Patrick N Breysse, Steven N Chillrud, Luke P Naeher, Charles E Rodes, Alan F Vette, John M Balbus
Affiliations

Health and household air pollution from solid fuel use: the need for improved exposure assessment

Maggie L Clark et al. Environ Health Perspect. 2013 Oct.

Abstract

Background: Nearly 3 billion people worldwide rely on solid fuel combustion to meet basic household energy needs. The resulting exposure to air pollution causes an estimated 4.5% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates.

Objective: We sought to identify research priorities for exposure assessment that will more accurately and precisely define exposure-response relationships of household air pollution necessary to inform future cleaner-burning cookstove dissemination programs.

Data sources: As part of an international workshop in May 2011, an expert group characterized the state of the science and developed recommendations for exposure assessment of household air pollution.

Synthesis: The following priority research areas were identified to explain variability and reduce uncertainty of household air pollution exposure measurements: improved characterization of spatial and temporal variability for studies examining both short- and long-term health effects; development and validation of measurement technology and approaches to conduct complex exposure assessments in resource-limited settings with a large range of pollutant concentrations; and development and validation of biomarkers for estimating dose. Addressing these priority research areas, which will inherently require an increased allocation of resources for cookstove research, will lead to better characterization of exposure-response relationships.

Conclusions: Although the type and extent of exposure assessment will necessarily depend on the goal and design of the cookstove study, without improved understanding of exposure-response relationships, the level of air pollution reduction necessary to meet the health targets of cookstove interventions will remain uncertain.

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Conflict of interest statement

This article is the work product of an employee of the NIEHS, NIH; however, the statements, opinions, or conclusions contained herein do not necessarily represent the statements, opinions, or conclusions of the NIEHS, the NIH, or the U.S. government. The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of the U.S. EPA. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.

C.E.R. has one patent application, 61/551,660, “Aerosol Exposure Monitoring;” S.N.C. has one patent application, 12/663,144, “Systems and Devices for Collecting Time and Space Resolved Air Samples,” and one provisional application, 61/594,637, “Wearable Ecodesigned Pack to Carry Portable Monitoring Technologies.” C.E.R. is employed by Research Triangle Institute, Research Triangle Park, NC. The other authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Reported means ± SDs of 24-hr PM (PM10, PM4, and PM2.5) concentrations and/or exposures (μg/m3) from selected studies included in the WHO Global household air pollution measurement database (http://www.who.int/indoorair/health_impacts/databases_iap/en/). Pollutant-specific WHO interim and guideline values, respectively, for air quality displayed refer to the annual guidelines of 70 μg/m3 and 10 μg/m3 for PM10 and 35 μg/m3 and 10 μg/m3 for PM2.5 (WHO 2006). Studies are labeled according to the reference, country, and reported PM fraction. For some studies reporting mean levels across multiple categories, such as season or fuel/kitchen type, results are shown as the pooled means and pooled SDs. Abbreviations: AM, arithmetic mean; EMR, Eastern Mediterranean Region; GM, geometric mean; ITG-1, interim target guideline; PM4, ≤ 4 μm in aerodynamic diameter; PM10, ≤ 10 μm in aerodynamic diameter; SEAR, Southeast Asian Region; WHOAQG, World Health Organization Air Quality Guideline; WPR, Western Pacific Region.
Figure 2
Figure 2
Reported means ± SDs from selected studies included in the WHO Global household air pollution measurement database that measured PM concentrations and/or exposures (μg/m3) before and after the introduction of an improved-combustion cookstove (http://www.who.int/indoorair/health_impacts/databases_iap/en/). Studies are labeled according to the reference, country, cookstove used, and reported PM fraction. Pollutant-specific WHO interim and guideline values, respectively, for air quality refer to the annual guidelines of 70 μg/m3 and 10 μg/m3 for PM10 and 35 μg/m3 and 10 μg/m3 for PM2.5 (WHO 2006). Abbreviations: AM, arithmetic mean; GM, geometric mean; ICS, improved combustion stove; ITG-1, interim target guideline; NISP, National Improved Stove Program; PM4, ≤ 4 μm in aerodynamic diameter; PM10, ≤ 10 μm in aerodynamic diameter; SEAR, Southeast Asian Region; WHOAQG, World Health Organization Air Quality Guideline; WPR, Western Pacific Region.
Figure 3
Figure 3
Hypothetical exposure–response relationship between PM2.5 and ALRI that illustrates how uncertainty in exposure assessment can limit the ability to accurately define the exposure reduction resulting from an intervention and, therefore, the true shape of the exposure–response curve.
See this image and copyright information in PMC

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