Primary Cooks Research Articles

From 'cooking wife' to 'cooking mother': Exploring generational shifts in perceptions regarding domestic cooking practices.

Utilising the life course perspective as the theoretical framework, we investigate how women from different generations perceive their cooking experiences and articulate their feelings regarding this activity. Following a review of the literature and four exploratory focus groups, an interview guide was developed and piloted. Interviews were conducted with 22 Brazilian women spanning three distinct generations. Participants were prompted to recall their life stories, spanning from childhood to the present day and focused on cooking-related situations. Interviews were transcripted and analysed using reflexive thematic analysis. There were three major themes developed. The first theme outlines variations in the food context across generations. The second theme encompasses perceptions of the responsibility for cooking as being linked to the female gender, indicating a generational shift from the role of the 'cooking wife' to that of the 'cooking mother'. The third theme explores thoughts and reflections on feelings of obligation, oppression, and liberation in cooking, tied to changes in the social and temporal context in which these women operate. Strategies promoting cooking should consider the meanings attributed to it, contribute to the deconstruction of gender-specific family dynamics, and encourage the pursuit for pleasure, satisfaction and autonomy in this practice. This study contributes novel insights into cooking, including reflections on obligation or oppression versus liberation and the evolving social roles of women as primary cooks.

Burden of headaches, eye irritation and respiratory symptoms among females stacking LPG with polluting cooking fuels: Modelling from peri-urban Cameroon, Ghana & Kenya

IntroductionLiquefied petroleum gas (LPG) is a clean cooking fuel that emits less household air pollution (HAP) than polluting cooking fuels (e.g. charcoal, wood). While switching from polluting fuels to LPG can reduce HAP and improve health, the impact of ‘stacking’ (concurrent use of polluting fuels and LPG) on adverse health symptoms (e.g. headaches, eye irritation, cough) among female cooks is uncertain. MethodsSurvey data from the CLEAN-Air(Africa) study was collected on cooking patterns and health symptoms over the last 12 months (cough, wheezing, chest tightness, shortness of breath, eye irritation, headaches) from approximately 400 female primary cooks in each of three peri‑urban communities in sub-Saharan Africa: Mbalmayo, Cameroon; Obuasi, Ghana; and Eldoret, Kenya. Random effects Poisson regression, adjusted for socioeconomic and health-related covariates, assessed the relationship between primary and secondary cooking fuel type and self-reported health symptoms. ResultsAmong 1,147 participants, 10 % (n = 118) exclusively cooked with LPG, 45 % (n = 509) stacked LPG and polluting fuels and 45 % (n = 520) exclusively cooked with polluting fuels. Female cooks stacking LPG and polluting fuels had significantly higher odds of shortness of breath (OR 2.16, 95 %CI:1.04–4.48) compared with those exclusively using LPG. In two communities, headache prevalence was 30 % higher among women stacking LPG with polluting fuels (Mbalmayo:82 %; Eldoret:65 %) compared with those exclusively using LPG (Mbalmayo:53 %; Eldoret:33 %). Women stacking LPG and polluting fuels (OR 2.45, 95 %CI:1.29–4.67) had significantly higher odds of eye irritation than women cooking exclusively with LPG. Second-hand smoke exposure was significantly associated with higher odds of chest tightness (OR 1.92, 95 % CI:1.19–3.11), wheezing (OR 1.76, 95 % CI:1.06–2.91) and cough (OR 1.78, 95 %CI:1.13–2.80). ConclusionsIn peri‑urban sub-Saharan Africa, women exclusively cooking with LPG had lower odds of several health symptoms than those stacking LPG and polluting fuels. Promoting a complete transition to LPG in these communities may likely generate short-term health benefits for primary cooks.

Carbon Monoxide Exposure and Risk of Cognitive Impairment Among Cooks in Africa

We use air pollution exposure measurements and household survey data from four studies conducted across three countries in sub‐Saharan Africa (SSA) to analyze the association between carbon monoxide (CO) exposure from cooking with biomass and indicators of cognitive impairment. While there is strong evidence on the relationship between ambient air pollution exposure and cognitive impairment from studies in high‐income countries, relatively little research has focused on household air pollution (HAP) in low‐income country settings where risks of HAP exposure are high. This study is the first to our knowledge to focus on the association between HAP exposure (specifically CO exposure) and cognitive impairment across diverse settings in SSA. We use 24‐hour measurements of primary cooks’ exposure to CO across four study sites: urban Zambia (n = 493); urban Malawi (n = 130); rural Malawi (n = 102); and urban Rwanda (n = 2,576). We model the estimated percent carboxyhemoglobin (%COHb) of cooks and map values to a toxicological profile for risk of cognitive impairment. We find that across all study settings, cooks’ average %COHb levels are below levels of daily concern, but that cooks who use charcoal for preparing greater than 40% of meals are more likely to spend additional time at higher levels of risk. For the urban Zambia sample, we compare %COHb and frequency of charcoal use to a series of cognitive test scores and find no consistent relationships between %COHb and cognitive test scores. High levels of daily CO exposure from cooks across SSA highlight the potential for longer‐term negative cognitive (and other) health outcomes motivating additional research and efforts to characterize and mitigate risk.

Household air pollution exposure and risk of tuberculosis: a case–control study of women in Lilongwe, Malawi

IntroductionGlobally, 3–4 billion people rely on solid fuels for cooking, and 1 billion use kerosene to light their homes. While household air pollution (HAP) emitted from burning these fuels has...

Estimating personal exposures to household air pollution and plastic garbage burning among adolescent girls in Jalapa, Guatemala

Waste collection services are uncommon in rural areas of low-resource countries, causing waste accumulation and subsequent dumping and burning of garbage. Air pollution from household garbage burning, including plastics, has been observed in Jalapa, Guatemala in addition to household air pollution (HAP) from cooking. Adolescent girls often help with these cooking and household tasks, but little is known about their exposures. We characterized 24-h exposures to HAP and household garbage burning in adolescent girls by measuring fine particulate matter (PM2.5), black carbon (BC), urinary biomarkers of polycyclic aromatic hydrocarbons (PAHs), bisphenol A (BPA), and phthalates. We recruited 60 girls between 13 and 17 years of age who helped with cooking activities and lived with participants of the Household Air Pollution Intervention Network (HAPIN) trial. We recruited n = 30 girls each from the control (wood-burning stove) and intervention (liquefied petroleum gas stove) arms. We also measured real-time kitchen concentrations of BC in 20 homes (33%). PM2.5 and BC were measured in n = 21 control and n = 20 intervention participants. Median concentrations of personal PM2.5 and BC and kitchen BC were lower (p < 0.05) in the intervention arm by 87%, 80%, and 85%, respectively. PAH metabolite concentrations were lower (p < 0.001) for all nine metabolites in intervention (n = 26) compared to control participants (n = 29). Urinary BPA concentrations were 66% higher in participants who reported using cosmetics (p = 0.02), and phthalate concentrations were 63% higher in participants who had reported using hair products during the sample period (p = 0.05). Our results suggest that gas stoves can reduce HAP exposures among adolescents who are not primary cooks at home. Biomarkers of plastic exposure were not associated with intervention status, but some were elevated compared to age- and sex-matched participants of the National Health and Nutrition Examination Survey (NHANES).

Socioeconomic determinants of household stove use and stove stacking patterns in Ghana

Air pollution is the fourth-highest risk factor for premature deaths globally and the second-highest risk factor for premature deaths in Ghana. Understanding the socioeconomic correlates of cooking stove/fuel choices and stove stacking patterns is a precursor to designing effective household air pollution interventions. The study applies the multinomial logit model (MNL) to identify socio-economic determinants of household cooking stoves in three unique analyses. In the first analysis, the study examines socio-economic determinants of primary stove choice for LPG, charcoal, and three-stone stoves. Secondly, the study examines determinants of stove choice for primary and secondary stoves when the order is not taken into account: LPG-charcoal, LPG-3-stone, and charcoal-3-stone. The third analysis examines determinants of stove use patterns among stove stackers when the order is taken into consideration: LPG-charcoal, LPG-3-stone, charcoal-3-stone, charcoal-LPG, 3-stone-LPG, and 3-stone-charcoal stove combinations. A cross-sectional design is used to collect data from sampled districts in all 16 regions of Ghana, covering about 7400 household-level respondents in 370 enumeration areas (EAs); across 177 urban EAs and 193 rural EAs.The results show that primary cooks with higher education, smaller, wealthier, and urban households are more likely to use LPG; more likely to use a stacking mix that includes LPG, and more likely to use a stacking combination where LPG is the primary stove-fuel used. Ghana is currently undertaking a National LPG Promotion Programme (NLPGPP) that seeks to increase LPG access by providing subsidized “starter kits” (stoves, regulators and cylinders) to periurban and rural households. Our findings can aid in targeting households effectively. Our results suggest that households that are female-headed; have less educated household heads; have household heads who double as the primary cook; have larger family sizes, have lower socio-economic status, and are rural, will have an increased probability of adopting and using a cleaner stack of cooking technologies and have an increased probability of using LPG long term, conditional on receiving a starter kit. Such a targeted intervention with a multifaceted approach to shifting households to a cleaner stack of cooking technologies could result in widespread adoption and contribute to significant reductions of CO and PM2.5 emissions in Ghana. A cleaner stack of cooking technologies, given the socio-demographics that are least likely to adopt and sustain use, will have a significant impact on health, the environment, and climate change.

Time for Clean Energy? Cleaner Fuels and Women’s Time in Home Production

AbstractIn much of the developing world, cooking accounts for the largest share of women’s time in home production. Does relying on solid fuels drive this time burden? This study revisits a clean energy information experiment in rural India to assess the time savings’ potential of cleaner cooking technologies. Treatment villages were randomly assigned to receive information about negative health effects of cooking with solid fuels and about public subsidies for cleaner liquid petroleum gas (LPG). Time-use data indicate that primary cooks spend almost 24 hours cooking each week. Cleaner fuel use is correlated with about 140 minutes less cooking time each week. Yet households only reduce their weekly cooking time by about 35 minutes in response to the randomized clean energy information nudge. Factors limiting the impact of clean energy nudges on the choice of home production technologies and time use are discussed and an avenue for future research is suggested.

PS-P03-11: EFFECT OF CLEANER COOKING FUEL (LPG) ON CARDIOPULMONARY HEALTH IN WOMEN FROM RURAL MAHARASHTRA

Background and Objective: Air pollution generated due to the use of solid fuels is recognized to be an environmental and health risk globally, especially in developing countries. Exposure to household air pollution is estimated to kill 3.8 million people worldwide. Major victims are women who are the immediate users. In an attempt to address this issue, the Indian government launched the Pradhan Mantri Ujjwala Yojana (PMUY) which provides clean LPG cooking gas to first-time users. However, it is majorly being promoted as a scheme about providing cooking gas to those who don’t have it but the health benefits of the scheme are not being focused. Accordingly, this study aimed to evaluate the effect of LPG on cardiopulmonary health in women. Design and method: A total of 997 healthy women participants (808 primary cooks and 189 secondary cooks) who cooked either with biomass or with LPG were enrolled. Systolic (SBP) and diastolic blood pressure (DBP), blood glucose was measured in all study participants and data on 24-hour personal exposure to fine particulate matter &lt; 2.5 μm (PM2.5) and lung function (by spirometry) were measured on a subset using a standard protocol. Socio-demographic data, cooking practices and other information were collected using a validated questionnaire. Descriptive analysis was done in SPSS v26. Results: Results highlighted that SBP, DBP, mean arterial pressure, pulse pressure and glucose level were significantly higher in the biomass group compared to the LPG group in both primary and secondary cooks. The prevalence of hypertension in primary and secondary cooks was 29.5 and 33.6 respectively in biomass users compared to 21.1 and 13.4 in LPG users. Higher number of obstructive airway pattern (n = 10; 6.4% vs n = 2 1.3%), restrictive airway pattern (n = 31; 19.7 % vs n = 19; 12.5 %) and small airway obstruction (n = 55; 35.0 % vs n = 22; 14.4 %) was observed in biomass group compared to LPG group respectively. After adjusting for age, BMI and study group, it was seen that biomass exposure index (odds ratio [OR] 2.288; 95% confidence interval [CI] 1.169, 4.479, P = 0.016) and PM2.5 levels (OR 1.065; 95% CI 1.035, 1.096, P &lt; 0.001) significantly increased the odds of having hypertension. Conclusions: Based on preliminary analysis, it can be concluded that the use of biomass is significantly associated with an increased risk of hypertension and impaired lung function. Thus, adoption of cleaner cooking fuels like LPG will have meaningful clinical and public health benefits.

Adoption of electricity for clean cooking in Cameroon: A mixed-methods field evaluation of current cooking practices and scale-up potential

Over 61 % of Cameroonians continue to rely on polluting fuels for cooking with negative consequences for health and the environment. To understand current and potential use of electricity as a clean energy source for cooking (eCooking), we conducted a mixed-methods study among households from three major urban/peri-urban centres in Cameroon: Douala, Yaoundé and Mbalmayo. Survey data from 1509 households, followed by an intensive one week “cooking diary” with 25 primary cooks and 10 semi-structured qualitative interviews, provided detailed information on cooking behaviours and fuel choices. Liquefied petroleum gas (LPG) was preferred for daily cooking, with firewood or charcoal used for traditional dishes. Electricity was used only as secondary or tertiary fuel by 20 % (n = 311) of survey respondents and only used once a week or less, mainly to cook rice and pasta or boiling water. For those households using eCooking, the most common appliances were rice cookers and hobs; smart-meters attached to the eCooking appliances showed high voltage fluctuation (<160 V to 250 + V) which are suboptimal for sustained eCooking use. To scale up adoption of electricity for clean cooking policies for (i) subsidising cost, (ii) strengthening reliability of service provision and (iii) addressing safety concerns are needed in addition to awareness-raising of the benefits and practicalities of using eCooking appliances for everyday meals.

Particulate Matter (Pm2.5) concentration among hypertensives primary cooks in Obuasi Municipality, Ghana

Particulate Matter (Pm2.5) concentration among hypertensives primary cooks in Obuasi Municipality, Ghana

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management.

The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy. An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework. Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy. Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

Reduced Black Carbon Concentrations following a Three-Year Stepped-Wedge Randomized Trial of the Wood-Burning Justa Cookstove in Rural Honduras.

Household air pollution from cooking-related biomass combustion remains a leading risk factor for global health. Black carbon (BC) is an important component of particulate matter (PM) in household air pollution. We evaluated the impact of the engineered, wood-burning Justa stove intervention on BC concentrations. We conducted a 3-year stepped-wedge randomized controlled trial with 6 repeated visits among 230 female primary cooks in rural Honduras. Participants used traditional stoves at baseline and were randomized to receive the Justa after visit 2 or after visit 4. At each visit, we measured 24-hour gravimetric personal and kitchen fine PM (PM2.5) concentrations and estimated BC mass concentrations (Sootscan Transmissometer). We conducted intent-to-treat analyses using linear mixed models with natural log-transformed 24-hour personal and kitchen BC. BC concentrations were reduced for households assigned to the Justa vs. traditional stoves: e.g., personal BC geometric mean (GSD), 3.6 μg/m3 (6.4) vs. 11.5 μg/m3 (4.6), respectively. Following the intervention, we observed 53% (95% CI: 35-65%) lower geometric mean personal BC concentrations and 76% (95% CI: 66-83%) lower geometric mean kitchen BC concentrations. The Justa stove intervention substantially reduced BC concentrations, mitigating household air pollution and potentially benefitting human and climate health.

Widening inequities in clean cooking fuel use and food security: compounding effects of COVID-19 restrictions and VAT on LPG in a Kenyan informal urban settlement

Universal access to cleaner cooking fuels (including liquefied petroleum gas (LPG)) is a key target of Sustainable Development Goal 7. Currently, approximately 40 million Kenyans rely on polluting cooking fuels (e.g. charcoal, wood). While the Kenyan government aims to rapidly scale up use of LPG for cooking by 2030, COVID-19 restrictions and a 16% value added tax (VAT) re-introduced on LPG in 2021 have likely hampered progress in LPG uptake. We aimed to quantify the effect of these economic shocks on food and energy security in Langas informal urban settlement in western Kenya. We further evaluated whether households most adversely affected by COVID-19 restrictions were more likely to be socioeconomically impacted by the VAT re-imposition. A cross-sectional survey (n = 1542) assessed changes in cooking fuel patterns, food security and livelihoods of primary cooks due to these two economic shocks. While under COVID-19 restrictions, 75% (n = 1147) of participants reported income declines and 18% (n = 164) of participants using LPG (n = 922) switched their primary cooking fuel to charcoal, wood or kerosene. Households reporting lower income while under COVID-19 restrictions had 5.3 times (95% CI:[3.8,7.4]) the odds of experiencing food insecurity as those with no change in income. Unemployment and food insecurity under COVID-19 restrictions were substantially higher among informal sector workers (70% and 60%, respectively) compared with business/government employees (45% and 37%, respectively). Following the VAT re-introduction, 44% (n = 356) of households using LPG consumed less, and 34% (n = 276) cooked more frequently with polluting fuels. Individuals switching away from LPG under COVID-19 restrictions had 3.0 times (95% CI:[2.1,4.3]) the odds of reducing their LPG consumption due to the VAT re-introduction as those maintaining use of LPG. COVID-19 restrictions and the VAT re-introduction disproportionately negatively affected informal sector workers’ livelihoods. A zero-rating of VAT on LPG can help alleviate deepened inequities in LPG access in Kenya.

Health impacts of a randomized biomass cookstove intervention in northern Ghana

BackgroundHousehold air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of “improved” biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only.MethodsTwo hundred rural households were randomized into four different cookstove groups. Surveys and health measurements were conducted at four time points over a two-year period. Chi-square tests were conducted to determine differences in self-reported health outcomes. Linear mixed models were used to assess the effect of the stoves on inflammation biomarkers in adults and children, and to assess the z-score deviance for the anthropometric data for children.ResultsWe find some evidence that two biomarkers of oxidative stress and inflammation, serum amyloid A and C-reactive protein, decreased among adult primary cooks in the intervention groups relative to the control group. We do not find detectable impacts for any of the anthropometry variables or self-reported health.ConclusionsOverall, we conclude that the REACCTING intervention did not substantially improve the health outcomes examined here, likely due to continued use of traditional stoves, lack of evidence of particulate matter emissions reductions from “improved” stoves, and mixed results for HAP exposure reductions.Clinical trial registryClinicalTrials.gov (National Institutes of Health); Trial Registration Number: NCT04633135; Date of Registration: 11 November 2020 – Retrospectively registered.URL: https://clinicaltrials.gov/ct2/show/NCT04633135?term=NCT04633135&draw=2&rank=1

Expanding the joys of cooking: How class shapes the emotional experience of family foodwork

AbstractThe emotional experience of foodwork is often considered along a continuum, where pleasure exists in opposition to labor, and where inequalities restrict pleasure. Analyzing qualitative interviews, recall conversations and cooking observations with 34 primary cooks in families, this article explores how diverse parents experience pleasure through family foodwork. Doing so reveals five conditions facilitating pleasure: time, choice, aesthetic freedom, connection, and appreciation. It then analyzes how access to these conditions is shaped by class inequalities, while being attentive to intersections with gender and race/ethnicity. This analysis reveals how socio‐economic inequalities fashion negative emotional relationships to foodwork by imposing disproportionate stressors on low‐income home cooks, but do not necessarily predict cooking pleasure. Through examining intersections between the sensory and material aspects of foodwork, this article furthers theoretical understanding into how foodwork reinforces gendered, racialized, and classed oppression, while simultaneously identifying how agency and empowerment operate through cooking pleasure for low‐income groups.

Insights into human behavior to inform exposure assessment using a low-cost, time-resolved location and activity monitoring system: a case study from a Ghanaian household energy study

Background: Human behaviors play a key role in determining patterns of exposure to environmental pollution. A better understanding of where and how people are spending their time can generate insights into ways to reduce overall exposure and associated health burdens. We develop a low-cost location and activity monitoring system designed for use in a household energy study, but with widespread applicability across the exposure sciences. Methods: The study sample includes 41 rural and 45 urban households in Northern Ghana enrolled in the Prices, Peers, and Perceptions (P3) cookstove study. To measure minute-to-minute variation in participants’ proximity to pollution sources at home and beyond the household, primary cooks were outfitted with wireless Bluetooth proximity monitors, GPS logging devices, and accelerometers (to measure instrument compliance) for multiple 2-day deployments. Minute-level location data were categorized into distinct classifications of ‘at home’ or ‘away’ and discrete zones of proximity to stoves. We examine compliance patterns, and then focus on days with high compliance (&gt;30% of 24hr period) to explore and model the variability of participant location among stove groups, hour of day, and urban vs. rural location. Results: Compliance is variable and low overall; we observe strong diurnal trends peaking at late morning and decreasing to lows around midnight. Focusing on a subset of 36 high-compliance deployment days, we find that location patterns can vary substantially within and between unique 24hr periods and across repeat visits. Participants are seldom compliant and away from home (&lt;5%). While at home, participants are closest to their stoves during dinner hours (14:00-19:00) and half of that time is spent within 5 meters of stoves. Conclusions: A low-cost sensor system can provide valuable behavioral information to inform exposure assessments. Understanding how to increase compliance with these systems could unlock the potential to provide actionable information for researchers and practitioners.

Exposure to household air pollution from wood-burning cookstoves and C-reactive protein among women in rural Honduras

Household air pollution from the burning of solid fuels is estimated to cause 1.6 million deaths annually and is an important risk factor for cardiovascular disease. Cardiovascular disease risk can be assessed by C-reactive protein (CRP) levels via dried blood spots in resource-limited settings. We evaluated the cross-sectional association of household air pollution and CRP among 106 female primary cooks in rural Honduras using wood-burning traditional or Justa stoves. We measured 24-hour gravimetric kitchen and personal fine particulate matter (PM2.5) and black carbon concentrations. Finger-stick blood samples were collected on filter paper for CRP analysis. Associations were evaluated using linear regression, adjusted for age, body mass index (BMI), education, and number of household assets. We assessed effect modification by risk factors age, BMI, glycated hemoglobin, and blood pressure.The median (25th-75th percentile) 24-hour average personal PM2.5 concentrations among traditional stoves users and Justa stove users were: 115 µg/m3 (65-154 µg/m3); 52 µg/m3 (39-81 µg/m3), respectively. Kitchen PM2.5 and kitchen and personal black carbon were also higher among traditional stove users. In adjusted analyses, higher concentrations of 24-hour average kitchen and personal PM2.5 and black carbon were associated with higher levels of CRP (e.g., a 25% increase in personal PM2.5 exposure was associated with a 10.5% increase in CRP [95% confidence interval: 1.2-20.6]). We only observed evidence of effect modification by levels of glycated hemoglobin. The association between personal PM2.5 and CRP was stronger among women with normal glycated hemoglobin levels compared to women with elevated glycated hemoglobin levels (p-interaction=0.01).Our results indicate that higher exposure to household air pollution is associated with higher levels of CRP among women in rural Honduras. The effect modification results only among women with normal blood sugar is contrary to our hypothesis and requires additional investigation. This does not necessarily reflect the policies of EPA.

Impacts of the COVID-19 Lockdown on Cooking Fuel Use Patterns, Income and Food Security in an Informal Settlement in Nairobi, Kenya

Background: Approximately 2.5 billion individuals use solid fuels (e.g. wood, coal) for cooking, exposing them to health-damaging household air pollution (HAP). A COVID-19 lockdown may impact the cooking habits, earning power, food security and health of millions of the urban poor living in informal settlements in low-income countries, Methods: Nairobi went into COVID-19-related lockdown on April 7, 2020. A telephone-based survey was conducted from April 20-30 to document socioeconomic impacts and fuel use among consenting participants (N=196) in the informal settlement of Mukuru kwa Reuben in Nairobi, Kenya. Change in cooking habits was assessed through comparison with baseline survey data collected from a random sample of primary cooks (N=285) in Mukuru kwa Reuben from December 2019-March 2020. Results: Nearly all participants (&gt;90%; 178) reported reduced (60%) or cessation (31%) of income and insufficient food (88%) as a result of the lockdown. A majority (52%) of participants reported cooking less frequently in response to the lockdown; most commonly (52%) in order to reduce household expenses and half (51%) had changed their diet (20% stopped consuming meat/fish). Half (n=38) of respondents using liquefied petroleum gas (LPG) for cooking had reduced (n=17; 23%) or stopped using LPG (n=21; 28%) as a clean primary fuel. Households switching primary fuels (n=29) commonly substituted LPG for wood (n=8; 28%) or kerosene (n=7; 24%); or kerosene for wood (n=9; 31%). Three-quarters of residents continuing to use LPG were paying a higher price since the lockdown; unavailability of LPG was not indicated as a major barrier. Conclusions: The COVID-19 lockdown has had a substantial impact on the livelihoods, fuel use and diets of families in peri-urban Kenya, including a likely increase in HAP exposures among families that stopped/reduced LPG fuel use for cooking. Increased exposure to HAP may have been compounded by being quarantined inside the home.

Lung function of primary cooks using LPG or biomass and the effect of particulate matter on airway epithelial barrier integrity

BackgroundCooks exposed to biomass fuel experience increased risk of respiratory disease and mortality. We sought to characterize lung function and environmental exposures of primary cooking women using two fuel-types in southeastern India, as well as to investigate the effect of particulate matter (PM) from kitchens on human airway epithelial (HAE) cells in vitro. MethodsWe assessed pre- and post-bronchodilator lung function on 25 primary female cooks using wood biomass or liquified petroleum gas (LPG), and quantified exposures from 34 kitchens (PM2.5, PM < 40 μm, black carbon, endotoxin, and PM metal and bacterial content). We then challenged HAE cells with PM, assessing its cytotoxicity to small-airway cells (A549) and its effect on: transepithelial conductance and macromolecule permeability (NuLi cells), and antimicrobial activity (using airway surface liquid, ASL, from primary HAE cells). ResultsLung function was impaired in cooks using both fuel-types. 60% of participants in both fuel-types had respiratory restriction (post bronchodilator FEV1/FVC>90). The remaining 40% in the LPG group had normal spirometry (post FEV1/FVC = 80–90), while only 10% of participants in the biomass group had normal spirometry, and the remaining biomass cooks (30%) had respiratory obstruction (post FEV1/FVC<80). Significant differences were found in environmental parameters, with biomass kitchens containing greater PM2.5, black carbon, zirconium, arsenic, iron, vanadium, and endotoxin concentrations. LPG kitchens tended to have more bacteria (p = 0.14), and LPG kitchen PM had greater sulphur concentrations (p = 0.02). In vitro, PM induced cytotoxicity in HAE A549 cells in a dose-dependent manner, however the effect was minimal and there were no differences between fuel-types. PM from homes of participants with a restrictive physiology increased electrical conductance of NuLi HAE cells (p = 0.06) and decreased macromolar permeability (p ≤ 0.05), while PM from homes of those with respiratory obstruction tended to increase electrical conductance (p = 0.20) and permeability (p = 0.07). PM from homes of participants with normal spirometry did not affect conductance or permeability. PM from all homes tended to inhibit antimicrobial activity of primary HAE cell airway surface liquid (p = 0.06). ConclusionsBiomass cooks had airway obstruction, and significantly greater concentrations of kitchen environmental contaminants than LPG kitchens. PM from homes of participants with respiratory restriction and obstruction altered airway cell barrier function, elucidating mechanisms potentially responsible for respiratory phenotypes observed in biomass cooks.

Prevalence of Chronic Bronchitis and Respiratory Health Profile of a Population Exposed to Wood Smoke in Nicaragua.

Background.Household air pollution (HAP) is one of the most important environmental risk factors worldwide associated with chronic respiratory diseases.Objectives.The present study focused on respiratory health in a population with high wood smoke exposure in Nicaragua.Methods.We employed a cross-sectional study with 213 participants. Data on the prevalence of chronic bronchitis (chronic bronchitis), chronic obstructive pulmonary disease (COPD) and asthma, including respiratory scores and pulmonary function tests, were documented. The role of risk factors for chronic bronchitis was analyzed.Results.We found a high prevalence of chronic airway diseases in the population exposed to wood smoke. A higher prevalence of chronic bronchitis was found in persons serving as primary cooks in households. Further confounding factors for chronic bronchitis included age, a prior diagnosis of asthma, inhalational allergies and lower socioeconomic status. Respiratory scores were elevated in individuals with chronic bronchitis.Conclusions.This is one of the first studies in a wood smoke-exposed population in Nicaragua showing a high prevalence of chronic bronchitis and COPD with an emphasis on the analysis of personal and environmental risk factors. Further studies are needed to address which combination of interventions is most efficient for ameliorating respiratory health hazards.Participant Consent.ObtainedEthics Approval.The study protocol was approved by the Ethics Committee of the University of Luebeck, Germany (reference number 12-214), and by the Ethics Committee of the Department of Medical Sciences at National Autonomous University of Nicaragua, Managua, Nicaragua.Competing Interests.The authors declare no competing financial interests.