Kirk R. Smith

An Integrated Risk Function for Estimating the Global Burden of Disease Attributable to Ambient Fine Particulate Matter Exposure

Background: Estimating the burden of disease attributable to long-term exposure to fine particulate matter (PM2.5) in ambient air requires knowledge of both the shape and magnitude of the relative risk (RR) function. However, adequate direct evidence to identify the shape of the mortality RR functions at the high ambient concentrations observed in many places in the world is lacking. Objective: We developed RR functions over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children < 5 years of age. Methods: We fit an integrated exposure–response (IER) model by integrating available RR information from studies of ambient air pollution (AAP), second hand tobacco smoke, household solid cooking fuel, and active smoking (AS). AS exposures were converted to estimated annual PM2.5 exposure equivalents using inhaled doses of particle mass. We derived population attributable fractions (PAFs) for every country based on estimated worldwide ambient PM2.5 concentrations. Results: The IER model was a superior predictor of RR compared with seven other forms previously used in burden assessments. The percent PAF attributable to AAP exposure varied among countries from 2 to 41 for IHD, 1 to 43 for stroke, < 1 to 21 for COPD, < 1 to 25 for LC, and < 1 to 38 for ALRI. Conclusions: We developed a fine particulate mass–based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available. Citation: Burnett RT, Pope CA III, Ezzati M, Olives C, Lim SS, Mehta S, Shin HH, Singh G, Hubbell B, Brauer M, Anderson HR, Smith KR, Balmes JR, Bruce NG, Kan H, Laden F, Prüss-Ustün A, Turner MC, Gapstur SM, Diver WR, Cohen A. 2014. An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure. Environ Health Perspect 122:397–403; http://dx.doi.org/10.1289/ehp.1307049

Chimney Stove Intervention to Reduce Long-term Wood Smoke Exposure Lowers Blood Pressure among Guatemalan Women

Background and Objective RESPIRE, a randomized trial of an improved cookstove, was conducted in Guatemala to assess health effects of long-term reductions in wood smoke exposure. Given the evidence that ambient particles increase blood pressure, we hypothesized that the intervention would lower blood pressure. Methods Two study designs were used: a) between-group comparisons based on randomized stove assignment, and b) before-and-after comparisons within subjects before and after they received improved stoves. From 2003 to 2005, we measured personal fine particle (particulate matter with aerodynamic diameter < 2.5 μm; PM2.5) exposures and systolic (SBP) and diastolic blood pressure (DBP) among women > 38 years of age from the chimney woodstove intervention group (49 subjects) and traditional open wood fire control group (71 subjects). Measures were repeated up to three occasions. Results Daily average PM2.5 exposures were 264 and 102 μg/m3 in the control and intervention groups, respectively. After adjusting for age, body mass index, an asset index, smoking, secondhand tobacco smoke, apparent temperature, season, day of week, time of day, and a random subject intercept, the improved stove intervention was associated with 3.7 mm Hg lower SBP [95% confidence interval (CI), −8.1 to 0.6] and 3.0 mm Hg lower DBP (95% CI, −5.7 to −0.4) compared with controls. In the second study design, among 55 control subjects measured both before and after receiving chimney stoves, similar associations were observed. Conclusion The between-group comparisons provide evidence, particularly for DBP, that the chimney stove reduces blood pressure, and the before-and-after comparisons are consistent with this evidence.

Millions Dead: How Do We Know and What Does It Mean? Methods Used in the Comparative Risk Assessment of Household Air Pollution

In the Comparative Risk Assessment (CRA) done as part of the Global Burden of Disease project (GBD-2010), the global and regional burdens of household air pollution (HAP) due to the use of solid cookfuels, were estimated along with 60+ other risk factors. This article describes how the HAP CRA was framed; how global HAP exposures were modeled; how diseases were judged to have sufficient evidence for inclusion; and how meta-analyses and exposure-response modeling were done to estimate relative risks. We explore relationships with the other air pollution risk factors: ambient air pollution, smoking, and secondhand smoke. We conclude with sensitivity analyses to illustrate some of the major uncertainties and recommendations for future work. We estimate that in 2010 HAP was responsible for 3.9 million premature deaths and ∼4.8% of lost healthy life years (DALYs), ranking it highest among environmental risk factors examined and one of the major risk factors of any type globally.

Pollutant Emissions and Energy Efficiency under Controlled Conditions for Household Biomass Cookstoves and Implications for Metrics Useful in Setting International Test Standards

Realistic metrics and methods for testing household biomass cookstoves are required to develop standards needed by international policy makers, donors, and investors. Application of consistent test practices allows emissions and energy efficiency performance to be benchmarked and enables meaningful comparisons among traditional and advanced stove types. In this study, 22 cookstoves burning six fuel types (wood, charcoal, pellets, corn cobs, rice hulls, and plant oil) at two fuel moisture levels were examined under laboratory-controlled operating conditions as outlined in the Water Boiling Test (WBT) protocol, Version 4. Pollutant emissions (carbon dioxide, carbon monoxide, methane, total hydrocarbons, and ultrafine particles) were continuously monitored. Fine particle mass was measured gravimetrically for each WBT phase. Additional measurements included cookstove power, energy efficiency, and fuel use. Emission factors are given on the basis of fuel energy, cooking energy, fuel mass, time, and cooking task or activity. The lowest PM(2.5) emissions were 74 mg MJ(delivered)(-1) from a technologically advanced cookstove compared with 700-1400 mg MJ(delivered)(-1) from the base-case open 3-stone cookfire. The highest thermal efficiency was 53% compared with 14-15% for the 3-stone cookfire. Based on these laboratory-controlled test results and observations, recommendations for developing potentially useful metrics for setting international standards are suggested.

The Lancet Commission on pollution and health

Philip J Landrigan, Richard Fuller, Nereus J R Acosta, Olusoji Adeyi, Robert Arnold, Niladri (Nil) Basu, Abdoulaye Bibi Baldé, Roberto Bertollini, Stephan Bose-O’Reilly, Jo Ivey Boufford, Patrick N Breysse, Thomas Chiles, Chulabhorn Mahidol, Awa M Coll-Seck, Maureen L Cropper, Julius Fobil, Valentin Fuster, Michael Greenstone, Andy Haines, David Hanrahan, David Hunter, Mukesh Khare, Alan Krupnick, Bruce Lanphear, Bindu Lohani, Keith Martin, Karen V Mathiasen, Maureen A McTeer, Christopher J L Murray, Johanita D Ndahimananjara, Frederica Perera, Janez Potočnik, Alexander S Preker, Jairam Ramesh, Johan Rockström, Carlos Salinas, Leona D Samson, Karti Sandilya, Peter D Sly, Kirk R Smith, Achim Steiner, Richard B Stewart, William A Suk, Onno C P van Schayck, Gautam N Yadama, Kandeh Yumkella, Ma Zhong

Air pollution and rural biomass fuels in developing countries: a pilot village study in India and implications for research and policy

The results of a pilot study in four Indian villages of personal exposure to total suspended particulates (TSP) and particulate benzo(a)pyrene (BaP) of women cooking on simple stoves using traditional biomass fuels are presented together with socioeconomic and fuel-use determinations. TSP exposures averaged nearly 7 mg m−3 and BaP about 4000 ng m −3 during the cooking period which occupied 10% of the year. The factors affecting indoor air pollution exposures in rural areas of developing countries are categorized and discussed by reference to the few published field measurements. Comparisons are made with other common exposures in urban and occupational settings. The sparse information indicates that rural exposures are relatively high. Subjects for future research are outlined and general policy implications mentioned.

Kerosene: a review of household uses and their hazards in low- and middle-income countries

Kerosene has been an important household fuel since the mid-19th century. In developed countries its use has greatly declined because of electrification. However, in developing countries, kerosene use for cooking and lighting remains widespread. This review focuses on household kerosene uses, mainly in developing countries, their associated emissions, and their hazards. Kerosene is often advocated as a cleaner alternative to solid fuels, biomass and coal, for cooking, and kerosene lamps are frequently used when electricity is unavailable. Globally, an estimated 500 million households still use fuels, particularly kerosene, for lighting. However, there are few studies, study designs and quality are varied, and results are inconsistent. Well-documented kerosene hazards are poisonings, fires, and explosions. Less investigated are exposures to and risks from kerosenes combustion products. Some kerosene-using devices emit substantial amounts of fine particulates, carbon monoxide (CO), nitric oxides (NOx), and sulfur dioxide (SO2). Studies of kerosene used for cooking or lighting provide some evidence that emissions may impair lung function and increase infectious illness (including tuberculosis), asthma, and cancer risks. However, there are few study designs, quality is varied, and results are inconsistent. Considering the widespread use in the developing world of kerosene, the scarcity of adequate epidemiologic investigations, the potential for harm, and the implications for national energy policies, researchers are strongly encouraged to consider collecting data on household kerosene uses in studies of health in developing countries. Given the potential risks of kerosene, policymakers may consider alternatives to kerosene subsidies, such as shifting support to cleaner technologies for lighting and cooking.

Health, environment and sustainable development : Identifying links and indicators to promote action

This paper discusses the links among health, environment, and sustainable development and presents a framework that extends from the epidemiological domain to the policy domain and includes the driving forces that generate environmental pressures, creating changes in the state of the environment and eventually contributing to human exposures. Health effects are the end result of this complex net of events. Environmental health interventions should not be limited to treatment of cases and directly reducing human exposures. The paper discusses the need for integrated action at all levels and, in particular, on the need to focus on long-term action directed at reducing the driving forces that generate the environmental health threats. Only this approach can achieve sustained health benefits and environmental protection in accord with the principles of sustainable development.

Household Cooking with Solid Fuels Contributes to Ambient PM2.5 Air Pollution and the Burden of Disease

Background: Approximately 2.8 billion people cook with solid fuels. Research has focused on the health impacts of indoor exposure to fine particulate pollution. Here, for the 2010 Global Burden of Disease project (GBD 2010), we evaluated the impact of household cooking with solid fuels on regional population-weighted ambient PM2.5 (particulate matter ≤ 2.5 μm) pollution (APM2.5). Objectives: We estimated the proportion and concentrations of APM2.5 attributable to household cooking with solid fuels (PM2.5-cook) for the years 1990, 2005, and 2010 in 170 countries, and associated ill health. Methods: We used an energy supply–driven emissions model (GAINS; Greenhouse Gas and Air Pollution Interactions and Synergies) and source-receptor model (TM5-FASST) to estimate the proportion of APM2.5 produced by households and the proportion of household PM2.5 emissions from cooking with solid fuels. We estimated health effects using GBD 2010 data on ill health from APM2.5 exposure. Results: In 2010, household cooking with solid fuels accounted for 12% of APM2.5 globally, varying from 0% of APM2.5 in five higher-income regions to 37% (2.8 μg/m3 of 6.9 μg/m3 total) in southern sub-Saharan Africa. PM2.5-cook constituted > 10% of APM2.5 in seven regions housing 4.4 billion people. South Asia showed the highest regional concentration of APM2.5 from household cooking (8.6 μg/m3). On the basis of GBD 2010, we estimate that exposure to APM2.5 from cooking with solid fuels caused the loss of 370,000 lives and 9.9 million disability-adjusted life years globally in 2010. Conclusions: PM2.5 emissions from household cooking constitute an important portion of APM2.5 concentrations in many places, including India and China. Efforts to improve ambient air quality will be hindered if household cooking conditions are not addressed. Citation: Chafe ZA, Brauer M, Klimont Z, Van Dingenen R, Mehta S, Rao S, Riahi K, Dentener F, Smith KR. 2014. Household cooking with solid fuels contributes to ambient PM2.5 air pollution and the burden of disease. Environ Health Perspect 122:1314–1320; http://dx.doi.org/10.1289/ehp.1206340

Performance testing for monitoring improved biomass stove interventions: experiences of the Household Energy and Health Project (1)

This paper describes the monitoring and evaluation of three improved cookstove dissemination projects implemented between 2004 and 2006 by non-governmental organizations (NGOs) in India and Mexico. The projects assessed stove performance using lab-based water boiling tests (WBTs), which yield a number of performance indicators including time to boil water, specific fuel consumption, and energy efficiency when the stove is operated at both high and low power output. They also conducted field-based kitchen performance tests (KPTs), which yield daily per capita fuel consumption in real cooking conditions. In addition, one NGO utilized a controlled cooking test, which combined elements of lab- and field-based tests. In all cases, improved cookstoves (ICSs) were compared to local traditional cookstoves (TCSs). The results of the WBTs were mixed. Although the improved stoves generally showed some improvement in efficiency for the low-power simmering phases, the stoves were less efficient than traditional stoves in high-power water-boiling phases. The results from the KPTs were much less ambiguous. Three ICS models were tested for fuel consumption during real household use. All ICSs showed statistically significant reductions (p < 0.05) in average daily per capita fuel use ranging from 19 to 67 %. We also explore the correlations between the outcomes in lab-based tests and field-based tests in order to understand the relationships between the two assessment methods. Only fuel consumption in the low-power phase of the WBT showed a strong correlation with fuel consumption in the field (r 2 = 0.83, p = 0.01). We discuss the implications of this association as well as the other outcomes and present some policy recommendations for monitoring and evaluation of large-scale stove interventions.