Using photovoice methods as a community-based participatory research tool to advance uptake of clean cooking and improve health: The LPG adoption in Cameroon evaluation studies.

Each year up to 2.6 million people die prematurely from household air pollution (HAP) due to cooking with polluting fuels such as wood and charcoal, particularly in low and middle-income countries (LMICs). The World Health Organisation recommends scaling the adoption of clean fuels to improve maternal and child health. Liquefied Petroleum Gas (LPG) represents a scalable clean fuel that provides health and environmental benefits when used for household energy in LMICs. In Cameroon, over 70% of people rely on biomass for cooking, and the Government aims to increase LPG use from <20% to 58% by 2030. Supporting households make this transition requires involvement of multiple stakeholders and an understanding of perspectives from the community's perspective. We used visual participatory methods 'Photovoice' to explore households' perceptions of factors influencing the uptake of LPG for cooking in South-West Cameroon. Two groups of participants from rural (n = 7) and peri-urban (n = 8) areas photographed subjects they identified as preventing and facilitating LPG uptake in their communities. Subsequently, individual interviews (n = 15) and group discussions (n = 5) explored participants' reflections on the photographs. Thematic analysis was conducted using NVivo 10 software. The main barriers identified included difficulty in affording the initial LPG equipment and ongoing refills, scarcity of LPG retail shops and refills, and safety concerns. Facilitators included (i) increasing awareness of the benefits of LPG (e.g. health), (ii) increasing retail outlet density in rural areas, (iii) addressing safety concerns (e.g. replacing damaged cylinders), and (iv) reducing the price of LPG refills. Participants presented their photos at a public exhibition, which generated discussions with key stakeholders (e.g. government ministries) about how best to assist communities in this transition. Photovoice was found to be an innovative and effective approach for exploring how to advance equitable access to LPG from a community perspective and successfully engage with key stakeholders.

Residual Inequity: Assessing the Unintended Consequences of New York City's Clean Heat Transition.

Energy policies and public health are intimately intertwined. In New York City, a series of policies, known as the Clean Heat Program (CHP), were designed to reduce air pollution by banning residual diesel fuel oils, #6 in 2015 and #4 by 2030. This measure is expected to yield environmental and public health benefits over time. While there is near-universal compliance with the #6 ban, a substantial number of buildings still use #4. In this paper, geographic analysis and qualitative interviews with stakeholders were used to interrogate the CHP's policy implementation in Northern Manhattan and the Bronx. A total of 1724 (53%) of all residential residual fuel burning buildings are located in this region. Stakeholders reflected mostly on the need for the program, and overall reactions to its execution. Major findings include that government partnerships with non-governmental organizations were effectively employed. However, weaknesses with the policy were also identified, including missed opportunities for more rapid transitions away from residual fuels, unsuccessful outreach efforts, cost-prohibitive conversion opportunities, and (the perception of) a volatile energy market for clean fuels. Ultimately, this analysis serves as a case study of a unique and innovative urban policy initiative to improve air quality and, consequently, public health.

Pressure cooker ownership and food security in Aurangabad, India.

OBJECTIVE: To explore associations between household food security and home gardening, use of soya and pressure cooker ownership in low-income households affected by HIV/AIDS in Aurangabad, India. DESIGN: Cross-sectional pilot study which assessed household food security using the validated US Department of Agriculture's food security core-module questionnaire. Questions were added to explore household environment, education, occupation, home gardening, use of soya and pressure cooker ownership. Households with very low v. low food security were compared using logistic regression analysis, controlling for confounding by socio-economic status. SETTING: Aurangabad is an urban setting situated in a primarily agricultural dependent area. The study was carried out in 2008, at the peak of the global food crisis. SUBJECTS: Adult caregivers of children affiliated with the Network of People Living with HIV/AIDS in Aurangabad. RESULTS: All except for one of 133 households were identified as food insecure (99.2 %). Of these households, 35.6 % had to cut size or skip a meal in the past 30 d. Households that cut meal size due to cooking fuel shortages were more likely to have very low food security (OR = 4.67; 95 % CI 1.62, 13.44) compared with households having no cooking fuel shortages. Owning a pressure cooker was shown to be protective against very low food security after controlling for confounding by socio-economic status (OR = 0.27; 95 % CI 0.11, 0.64). CONCLUSIONS: Only pressure cooker ownership showed a protective association with low household food security. Pressure cookers save household fuel costs. Therefore, future interventions should explore pressure cookers as a sustainable means of improving household food security.

Global burden of disease as a result of indoor air pollution in Shaanxi, Hubei and Zhejiang, China.

Indoor air pollution in developing countries is a major global health problem, yet estimates of the global burden of disease vary widely and are associated with large uncertainty. The World Health Organization uses the fuel based approach to estimate 1.6 million premature deaths globally each year associated with exposure to indoor air pollution, of which 420000 are in China. The fuel based approach uses a ventilation factor to account for differences in indoor air concentrations and exposures in different parts of the world based on regional differences in stove technology. In China this approach assumes that flues eliminate the majority of indoor air pollution, with a ventilation factor of 0.25. To account for historic exposure leading to current disease patterns the ventilation factor was adjusted to 0.5 for adult health endpoints. Measurements in three Chinese provinces, Shaanxi, Hubei and Zhejiang, however, show that high PM(4) concentrations are present in kitchens and living rooms even with stoves with flues as a result of multiple stove and flue use. Comparison of Indian and Chinese indoor air concentrations suggests more appropriate ventilation factors in the range 0.76-1.0 for women and children, and 1.0 for men. Premature mortality in the three provinces using these estimates would be closer to 60600, rather than current estimates of 46000. With the addition of cardiovascular diseases these estimates would increase by 92000. Pollutant based estimates using measured indoor air concentrations and combined with dose-response estimates would imply a burden of disease of 157800 premature deaths including cardiovascular diseases, a tripling of current estimates.

Personal and indoor exposure to PM2.5 and polycyclic aromatic hydrocarbons in the southern highlands of Tanzania: a pilot-scale study.

Personal and indoor exposure to PM(2.5) and polycyclic aromatic hydrocarbons (PAHs) were measured in households in the Njombe district of Tanzania. Cooking is conducted indoors in this region due to its high elevation, cool climate, and heavy seasonal rainfall. Kitchens are often poorly ventilated, resulting in high exposures to combustion-related pollutants. Sampling sites were selected to represent typical cooking practices across regional socio-economic divisions. These include the use of open wood fires, charcoal, a mix of charcoal and kerosene, and liquid petroleum gas (LPG) for cooking fuels. PM(2.5) average personal exposure was 14 µg/m(3) (±3, n = 3) for LPG, 88 µg/m(3) (±42, n = 3) for kerosene/charcoal mix, 588 µg/m(3) (±347, n = 3) for charcoal alone, and 1574 µg/m(3) (±287, n = 3) for open wood fires. Total PAH average personal exposures were less than 1 ng/m(3) (±1, n = 3) for LPG, 57 ng/m(3) (±16, n = 3) for kerosene/charcoal mix, 334 ng/m(3) (±57, n = 3) for charcoal alone, and 5040 ng/m(3) (±909, n = 3) for open wood fires. Benzo[a]pyrene equivalent exposures for US EPA's priority PAH pollutants were 0 for LPG, 8 ng/m(3) for kerosene/charcoal mix, 44 ng/m(3) for charcoal, and 767 ng/m(3) for open wood fire. Inhalable pollutants are present at unacceptably high levels, exceeding indoor air quality standards for all but LPG fuels. Relative results provide an exposure profile for rural East Africa and support the feasibility of conducting a larger scale smoke exposure campaign in the region. The use of "fuel efficient" wood stoves for the reduction of PM(2.5) and PAH exposure was measured in a local secondary school. Proper use of "fuel efficient" wood stoves reduced personal and indoor exposure to measured pollutants by more than 90%, supporting further investigation into the applicability of this technology to significantly improve indoor air quality.

Energy use and emissions from marine vessels: a total fuel life cycle approach.

Regional and global air pollution from marine transportation is a growing concern. In discerning the sources of such pollution, researchers have become interested in tracking where along the total fuel life cycle these emissions occur. In addition, new efforts to introduce alternative fuels in marine vessels have raised questions about the energy use and environmental impacts of such fuels. To address these issues, this paper presents the Total Energy and Emissions Analysis for Marine Systems (TEAMS) model. TEAMS can be used to analyze total fuel life cycle emissions and energy use from marine vessels. TEAMS captures "well-to-hull" emissions, that is, emissions along the entire fuel pathway, including extraction, processing, distribution, and use in vessels. TEAMS conducts analyses for six fuel pathways: (1) petroleum to residual oil, (2) petroleum to conventional diesel, (3) petroleum to low-sulfur diesel, (4) natural gas to compressed natural gas, (5) natural gas to Fischer-Tropsch diesel, and (6) soybeans to biodiesel. TEAMS calculates total fuel-cycle emissions of three greenhouse gases (carbon dioxide, nitrous oxide, and methane) and five criteria pollutants (volatile organic compounds, carbon monoxide, nitrogen oxides, particulate matter with aerodynamic diameters of 10 microm or less, and sulfur oxides). TEAMS also calculates total energy consumption, fossil fuel consumption, and petroleum consumption associated with each of its six fuel cycles. TEAMS can be used to study emissions from a variety of user-defined vessels. This paper presents TEAMS and provides example modeling results for three case studies using alternative fuels: a passenger ferry, a tanker vessel, and a container ship.

Indoor air pollution by emissions of fossil fuel single stoves: possibly a hitherto underrated risk factor in the development of carcinomas in the head and neck.

We have carried out three case-control studies on the relative risk of head and neck cancer in association with indoor air pollution. The studies performed at the Department of Otorhinolaryngology of the University of Heidelberg comprised 369 male patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx and 1476 healthy control subjects matched for sex, age, and residential area. The OR of laryngeal cancer related to daily exposure to fossil fuels due to stove-heating with oil, coal, gas, and wood for longer than 40 years was 2.5 (CI = 1.51 to 4.05). After adjustment for tobacco and alcohol, the OR declined slightly to 2.0 (CI = 1.10 to 3.46) but still was significant. Elevated ORs were also found for daily presence in a kitchen with an oil, coal, or wood oven for longer than 40 years (OR = 1.7, CI = 1.01 to 2.71; after tobacco and alcohol adjustment, OR = 1.4, CI = 0.76 to 2.41). The OR of pharyngeal cancer related to daily exposure to fossil fuels due to stove-heating with oil, coal, gas, and wood for longer than 40 years was 3.6 (CI = 2.04 to 6.41). After adjustment for tobacco and alcohol the OR declined slightly to 3.3 (CI = 1.43 to 7.55) but still was significant. Elevated ORs were also found for daily presence in a kitchen with an oil, coal, or wood oven for longer than 40 years (OR = 1.6, CI = 0.89 to 2.77; after tobacco and alcohol adjustment, OR = 2.5, CI = 1.03 to 6.30).(ABSTRACT TRUNCATED AT 250 WORDS)