title: Chimney stove intervention to reduce long-term wood smoke exposure lowers blood pressure among Guatemalan women.
abstract: 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 microm; PM(2.5)) 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 PM(2.5) exposures were 264 and 102 microg/m(3) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02215, USA. jmccrack@hsph.harvard.edu
authors.forename: John P
authors.initials: JP
authors.lastname: McCracken
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
authors.forename: Anaité
authors.initials: A
authors.lastname: Díaz
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D016902:Air Pollution, Indoor; D001794:Blood Pressure; D005260:Female; D006166:Guatemala; D006801:Humans; D012906:Smoke; D014934:Wood
chemical_list: D012906:Smoke