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: Results from the KidsAIR Randomized Trial

Ethan S. Walker, Erin O. Semmens, Annie Belcourt, Bert B. Boyer, Esther Erdei, Jon Graham, Scarlett E. Hopkins, Johnnye L. Lewis, Paul G. Smith, Desirae Ware, Emily Weiler, Tony J. Ward, Curtis W. Noonan

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Abstract

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 formula presented in aerodynamic diameter (formula presented )] 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 formula presented 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 formula presented of age. We tracked LRTI cases for two consecutive winter seasons and measured indoor formula presented over a 6-d period during the first winter. We assessed results using two analytical frameworks: a) intervention efficacy on LRTI and formula presented (intent-to-treat), and b) association between formula presented 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 education arm [formula presented ; 95% confidence interval (CI): 0.35, 2.72] and the filtration arm (formula presented ; 95% CI: 0.46, 3.32) had similar odds of LRTI vs. control. Geometric mean formula presented concentrations were similar to control in the education arm (11.77% higher; 95% CI: formula presented , 49.72) and air filtration arm (6.96% lower; 95% CI: formula presented , 24.55). In the exposure-response analysis, odds of LRTI were 1.45 times higher (95% CI: 1.02, 2.05) per interquartile range (formula presented ) increase in mean indoor formula presented . DISCUSSION: We did not observe meaningful differences in LRTI or indoor formula presented 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. https://doi.org/10.1289/EHP9932.

Original languageEnglish (US)
Pages (from-to)47002
Number of pages1
JournalEnvironmental health perspectives
Volume130
Issue number4
DOIs
StatePublished - Apr 1 2022

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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