title: A panel study of the acute effects of personal exposure to household air pollution on ambulatory blood pressure in rural Indian women.
abstract: BACKGROUND
  Almost half the world's population is exposed to household air pollution from biomass and coal combustion. The acute effects of household air pollution on the cardiovascular system are poorly characterized. We conducted a panel study of rural Indian women to assess whether personal exposures to black carbon during cooking were associated with acute changes in blood pressure.
  
  
  METHODS
  We enrolled 45 women (ages 25-66 years) who cooked with biomass fuels. During cooking sessions in winter and summer, we simultaneously measured their personal real-time exposure to black carbon and conducted ambulatory blood pressure measurements every 10min. We recorded ambient temperature and participants' activities while cooking. We assessed body mass index, socioeconomic status, and salt intake. Multivariate mixed effects regression models with random intercepts were used to estimate the associations between blood pressure and black carbon exposure, e.g., average exposure in the minutes preceding blood pressure measurement, and average exposure over an entire cooking session.
  
  
  RESULTS
  Women's geometric mean (GM) exposure to black carbon during cooking sessions was lower in winter (GM: 40μg/m(3); 95% CI: 30, 53) than in summer (GM: 56μg/m(3); 95% CI: 42, 76). Interquartile range increases in black carbon were associated with changes in systolic blood pressure from -0.4mm Hg (95% CI: -2.3, 1.5) to 1.9mm Hg (95% CI: -0.8, 4.7), with associations increasing in magnitude as black carbon values were assessed over greater time periods preceding blood pressure measurement. Interquartile range increases in black carbon were associated with small decreases in diastolic blood pressure from -0.9mm Hg (95% CI: -1.7, -0.1) to -0.4mm Hg (95% CI: -1.6, 0.8). Associations of a similar magnitude were estimated for cooking session-averaged values.
  
  
  CONCLUSIONS
  We found some evidence of an association between exposure to black carbon and acute increases in systolic blood pressure in Indian women cooking with biomass fuels, which may have implications for the development of cardiovascular diseases.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Norris
authors.affiliation: Department of Medicine, McGill University, Montreal, QC, Canada; Division of Clinical Epidemiology, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Goldberg
authors.affiliation: Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Julian D
authors.initials: JD
authors.lastname: Marshall
authors.affiliation: Department of Medicine, McGill University, Montreal, QC, Canada; Division of Clinical Epidemiology, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Valois
authors.affiliation: SAMUHA, Kanakagiri, Karnataka, India.
authors.forename: T
authors.initials: T
authors.lastname: Pradeep
authors.affiliation: SAMUHA, Kanakagiri, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Narayanswamy
authors.affiliation: SAMUHA, Kanakagiri, Karnataka, India.
authors.forename: Grishma
authors.initials: G
authors.lastname: Jain
authors.affiliation: SAMUHA, Kanakagiri, Karnataka, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Sethuraman
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Institute for Health and Social Policy, McGill University, Montreal, QC, Canada. Electronic address: jill.baumgartner@mcgill.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D003296:Cooking; D005260:Female; D006801:Humans; D007194:India; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D012621:Seasons; D053260:Soot / Q000009:adverse effects* / Q000032:analysis
chemical_list: D000393:Air Pollutants; D053260:Soot
keywords: Acute effects; Biomass combustion; Black carbon; Cardiovascular; Panel study