Project location: Rural areas of southwest Alaska, Montana and Arizona
Category: Respiratory Health
Acute lower respiratory tract infections (LRTIs) account for more than 27% of all hospitalizations among US children under five years of age, with recurrent LRTIs in children a recognized risk factor for asthma. Within rural areas of Montana, Alaska, and the Navajo Reservation, research has shown that residential biomass combustion leads to elevated indoor levels of fine particulate matter (PM2.5) that often exceed current health based air quality standards. Parallel findings have been observed in several developing countries where biomass combustion is commonly used for cooking and/or heating. This is concerning, as PM2.5 exposure is associated with many adverse health outcomes, including a greater than three-fold increased risk of LRTIs.
Currently, there is a global effort to reduce indoor biomass smoke exposures in developing countries through the introduction of improved cookstove technology. Similar evidence-based efforts are warranted in rural and Native American communities in the US that suffer from elevated rates of childhood LRTI and commonly use wood for residential heating. To date, exposure reduction strategies in wood stove homes have been either inconsistently effective or include factors that limit widespread dissemination and continued compliance in rural populations. In this project, we are testing the efficacy of two intervention strategies for reducing indoor wood smoke PM2.5 exposures and children's risk of LRTI in three unique settings: (1) rural mountain valley communities in western Montana; (2) Navajo Nation communities; and (3) Alaska Native Communities. We are conducting a three-arm randomized placebo-controlled post only intervention trial in wood stove homes with children less than five years old. Education on best-burn practices and training on the use of simple instruments (i.e., stove thermometers and wood moisture meters) will be introduced as one intervention arm. This intervention will be evaluated against using an indoor air filtration unit. The primary outcome will be LRTI incidence among children under five years of age. The overall hypothesis is that a low-cost, educational intervention targeting indoor wood smoke PM2.5 exposures will be sustainable, and can reduce children's risk of LRTI in underserved Native and rural communities.
CANHR Staff: Bert Boyer, Scarlett Hopkins, Kenlynn Henry, and Grace Anaver
University of Montana Staff: Tony Ward and Curtis Noonan (PIs)
Funded by: NIH NIEHS R01ES022649