Biomonitoring Human Exposure to Household Air Pollution and Association with Self-reported Health Symptoms - A Stove Intervention Study in Peru.
Household air pollution (HAP) from indoor biomass stoves contains harmful pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and is a leading risk factor for global disease burden. We used biomonitoring to assess HAP exposure and association with self-reported symptoms in 334 non-smoking Peruvian women to evaluate the efficacy of a stove intervention program.



We conducted a cross-sectional study within the framework of a community randomized control trial. Using urinary PAH metabolites (OH-PAHs) as the exposure biomarkers, we investigated whether the intervention group (n=155, with new chimney-equipped stoves) were less exposed to HAP compared to the control group (n=179, with mostly open-fire stoves). We also estimated associations between the exposure biomarkers, risk factors, and self-reported health symptoms, such as recent eye conditions, respiratory conditions, and headache.



We observed reduced headache and ocular symptoms in the intervention group than the control group. Urinary 2-naphthol, a suggested biomarker for inhalation PAH exposure, was significantly lower in the intervention group (GM with 95% CI: 13.4 [12.3, 14.6] μg/g creatinine) compared to control group (16.5 [15.0, 18.0] μg/g creatinine). Stove type and/or 2-naphthol was associated with a number of self-reported symptoms, such as red eye (adjusted OR with 95% CI: 3.80 [1.32, 10.9]) in the past 48h.



Even with the improved stoves, the biomarker concentrations in this study far exceeded those of the general populations and were higher than a no-observed-genotoxic-effect-level, indicating high exposure and a potential for increased cancer risk in the population.
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, USA; Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Sciences, Atlanta, USA. Electronic address: ZJLi@cdc.gov.
Zheng
Z
Li
Medical University of South Carolina, Charleston, USA.
Adwoa
A
Commodore
Instituto de Investigación Nutricional, Lima, Perú; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Universidad Peruana Cayetano Heredia, Lima, Perú.
Stella
S
Hartinger
Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Sciences, Atlanta, USA.
Michael
M
Lewin
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, USA.
Andreas
A
Sjödin
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, USA.
Erin
E
Pittman
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, USA.
Debra
D
Trinidad
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, USA.
Kendra
K
Hubbard
Instituto de Investigación Nutricional, Lima, Perú.
Claudio F
CF
Lanata
Instituto de Investigación Nutricional, Lima, Perú.
Ana I
AI
Gil
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Daniel
D
Mäusezahl
Universidad Peruana Cayetano Heredia, Lima, Perú; University of Georgia, Athens, USA.
Luke P
LP
Naeher
D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D015415:Biomarkers / Q000652:urine; D018533:Biomass; D003296:Cooking; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D004784:Environmental Monitoring; D005128:Eye Diseases / Q000139:chemically induced; D005260:Female; D005390:Fires; D006261:Headache / Q000139:chemically induced; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D009284:Naphthols / Q000652:urine; D010568:Peru; D011084:Polycyclic Aromatic Hydrocarbons / Q000009:adverse effects; D012140:Respiratory Tract Diseases / Q000139:chemically induced; D057566:Self Report; D012906:Smoke / Q000009:adverse effects
D015415:Biomarkers; D009284:Naphthols; D011084:Polycyclic Aromatic Hydrocarbons; D012906:Smoke; C028405:2-naphthol
1-hydroxypyrene; biomonitoring; household air pollution; polycyclic aromatic hydrocarbon; stove intervention; woodsmoke
Am J Epidemiol. 2009 Jul 15;170(2):211-20
19443665
Epidemiol Rev. 2010;32:70-81
20378629
Sci Total Environ. 2008 Feb 15;390(2-3):362-8
18036639
Thorax. 2010 Mar;65(3):221-8
20335290
Int Arch Occup Environ Health. 2010 Aug;83(6):617-23
19885669
J Environ Monit. 2010 May;12 (5):1110-18
21491629
Am J Respir Crit Care Med. 2009 Oct 1;180(7):649-56
19556519
Am J Physiol Lung Cell Mol Physiol. 2013 May 1;304(9):L571-8
23457186
Indoor Air. 2012 Apr;22(2):140-7
21985234
Contemp Clin Trials. 2011 Nov;32(6):864-73
21762789
Anal Bioanal Chem. 2014 May;406(13):3119-29
24714969
Toxicol Lett. 2014 Dec 1;231(2):239-48
24831967
Environ Health Perspect. 2005 Feb;113(2):192-200
15687057
J Expo Sci Environ Epidemiol. 2012 Jan-Feb;22(1):46-51
21971380
J Expo Sci Environ Epidemiol. 2016 May-Jun;26(3):241-8
25605446
Environ Health Perspect. 2014 Feb;122(2):120-30
24300100
Ann Occup Hyg. 2000 Mar;44(2):89-100
10717260
Indoor Air. 2013 Aug;23(4):342-52
23311877
Environ Sci Technol. 2013;47(23):13602-10
24187943
Saf Health Work. 2014 Jun;5(2):86-90
25180139
Int J Environ Health Res. 2009 Oct;19(5):357-68
19626518
J Expo Sci Environ Epidemiol. 2010 Sep;20(6):526-35
19707251
PLoS One. 2014 Dec 02;9(12):e113920
25463771
Sci Total Environ. 1998 Jun 30;217(1-2):175-83
9695181
Mutat Res. 1999 Sep 30;445(2):147-53
10575425
Arch Environ Health. 2002 Jul-Aug;57(4):377-82
12530608
Int Arch Occup Environ Health. 1997;70(4):257-60
9342626
Int J Hyg Environ Health. 2003 Jan;206(1):15-24
12621899
Inhal Toxicol. 2007 Jan;19(1):67-106
17127644
Environ Int. 2011 Oct;37(7):1157-63
21524795
Thorax. 2015 May;70(5):433-41
25758120
Lancet. 2015 Dec 5;386(10010):2287-323
26364544
Int J Occup Environ Health. 2013 Jan-Mar;19(1):43-54
23582614
Environ Health. 2015 Mar 15;14:24
25890249
Environ Toxicol Pharmacol. 2015 Sep;40(2):423-9
26276550
Environ Health Perspect. 2011 Sep;119(9):1301-7
21622083
Drug Chem Toxicol. 2015 ;38(3):349-54
25308554
Int Arch Occup Environ Health. 2003 Oct;76(8):556-76
12920524
Arch Environ Contam Toxicol. 1999 Jan;36(1):99-108
9828267
Int J Environ Res Public Health. 2013 Oct 25;10(11):5378-98
24284355
Toxicology. 2000 Feb 7;143(1):1-118
10675783
Cancer Epidemiol Biomarkers Prev. 2004 Jun;13(6):1005-12
15184257
J Epidemiol Community Health. 2007 Jan;61(1):74-9
17183019
Chem Res Toxicol. 2012 Apr 16;25(4):952-64
22428611
Environ Health Perspect. 2015 Apr;123(4):285-92
25398189
PLoS One. 2014 Mar 10;9(3):e91011
24614750
Environ Sci Pollut Res Int. 2016 Apr;23 (7):6816-25
26662953
Environ Health Perspect. 2007 Jun;115(6):848-55
17589590
Int Arch Occup Environ Health. 2000 Jul;73(5):331-8
10963417
Environ Health Perspect. 2012 May;120(5):637-45
22296719