TY - JOUR
T1 - Efficacy of Air Filtration and Education Interventions on Indoor Fine Particulate Matter and Child Lower Respiratory Tract Infections among Rural U.S. Homes Heated with Wood Stoves
T2 - Results from the KidsAIR Randomized Trial
AU - Walker, Ethan S.
AU - Semmens, Erin O.
AU - Belcourt, Annie
AU - Boyer, Bert B.
AU - Erdei, Esther
AU - Graham, Jon
AU - Hopkins, Scarlett E.
AU - Lewis, Johnnye L.
AU - Smith, Paul G.
AU - Ware, Desirae
AU - Weiler, Emily
AU - Ward, Tony J.
AU - Noonan, Curtis W.
N1 - Funding Information:
The study was funded by the National Institutes of Health (NIH)/ National Institute of Environmental Health Sciences (NIEHS; 1R01ES022649 to C.W.N.). Development of the educational intervention was also supported by the NIEHS (1R01ES022583 to C.W.N.). Additional support was provided by the National Institutes of Health Office of the Director Environmental Influences on Child Health Outcomes IDeA States Pediatric Clinical Trials Network (8UG1OD024952 to P.G.S.) and the National Institute of General Medical Sciences (1P20GM130418 to C.W.N.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2022, Public Health Services, US Dept of Health and Human Services. All rights reserved.
PY - 2022/4
Y1 - 2022/4
N2 - BACKGROUND: Millions of rural U.S. households are heated with wood stoves. Wood stove use can lead to high indoor concentrations of fine particulate matter [airborne particles ≤2.5 µm in aerodynamic diameter (PM2.5)] and is associated with lower respiratory tract infection (LRTI) in children. OBJECTIVES: We assessed the impact of low-cost educational and air filtration interventions on childhood LRTI and indoor PM2.5 in rural U.S. homes with wood stoves. METHODS: The Kids Air Quality Interventions for Reducing Respiratory Infections (KidsAIR) study was a parallel three-arm (education, portable air filtration unit, control), post-only randomized trial in households from Alaska, Montana, and Navajo Nation (Arizona and New Mexico) with a wood stove and one or more children <5 years of age. We tracked LRTI cases for two consecutive winter seasons and measured indoor PM2.5 over a 6-d period during the first winter. We assessed results using two analytical frameworks: A) intervention efficacy on LRTI and PM2.5 (intent-to-treat), and b) association betweenPM2.5 and LRTI (exposure-response). RESULTS: There were 61 LRTI cases from 14,636 child-weeks of follow-up among 461 children. In the intent-to-treat analysis, children in the educa-tion arm [odds ratio (OR) =0.98; 95% confidence interval (CI): 0.35, 2.72] and the filtration arm (OR = 1.23; 95% CI: 0.46, 3.32) had similar odds of LRTI vs. control. Geometric mean PM2.5 concentrations were similar to control in the education arm (11.77% higher; 95% CI: -16.57, 49.72) and air filtration arm (6.96% lower; 95% CI: -30.50, 24.55). In the exposure-response analysis, odds of LRTI were 1.45 times higher (95% CI: 1.02, 2.05) per interquartile range (25 µg/m3) increase in mean indoor PM2.5. DISCUSSION: We did not observe meaningful differences in LRTI or indoor PM2.5 in the air filtration or education arms compared with the control arm. Results from the exposure-response analysis provide further evidence that biomass air pollution adversely impacts childhood LRTI. Our results highlight the need for novel, effective intervention strategies in households heated with wood stoves.
AB - BACKGROUND: Millions of rural U.S. households are heated with wood stoves. Wood stove use can lead to high indoor concentrations of fine particulate matter [airborne particles ≤2.5 µm in aerodynamic diameter (PM2.5)] and is associated with lower respiratory tract infection (LRTI) in children. OBJECTIVES: We assessed the impact of low-cost educational and air filtration interventions on childhood LRTI and indoor PM2.5 in rural U.S. homes with wood stoves. METHODS: The Kids Air Quality Interventions for Reducing Respiratory Infections (KidsAIR) study was a parallel three-arm (education, portable air filtration unit, control), post-only randomized trial in households from Alaska, Montana, and Navajo Nation (Arizona and New Mexico) with a wood stove and one or more children <5 years of age. We tracked LRTI cases for two consecutive winter seasons and measured indoor PM2.5 over a 6-d period during the first winter. We assessed results using two analytical frameworks: A) intervention efficacy on LRTI and PM2.5 (intent-to-treat), and b) association betweenPM2.5 and LRTI (exposure-response). RESULTS: There were 61 LRTI cases from 14,636 child-weeks of follow-up among 461 children. In the intent-to-treat analysis, children in the educa-tion arm [odds ratio (OR) =0.98; 95% confidence interval (CI): 0.35, 2.72] and the filtration arm (OR = 1.23; 95% CI: 0.46, 3.32) had similar odds of LRTI vs. control. Geometric mean PM2.5 concentrations were similar to control in the education arm (11.77% higher; 95% CI: -16.57, 49.72) and air filtration arm (6.96% lower; 95% CI: -30.50, 24.55). In the exposure-response analysis, odds of LRTI were 1.45 times higher (95% CI: 1.02, 2.05) per interquartile range (25 µg/m3) increase in mean indoor PM2.5. DISCUSSION: We did not observe meaningful differences in LRTI or indoor PM2.5 in the air filtration or education arms compared with the control arm. Results from the exposure-response analysis provide further evidence that biomass air pollution adversely impacts childhood LRTI. Our results highlight the need for novel, effective intervention strategies in households heated with wood stoves.
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U2 - 10.1289/EHP9932
DO - 10.1289/EHP9932
M3 - Article
C2 - 35394807
AN - SCOPUS:85127844654
VL - 130
JO - Environmental Health Perspectives
JF - Environmental Health Perspectives
SN - 0091-6765
IS - 4
M1 - 047002
ER -