The goal of this Career Development Award is to initiate an independent research program in air pollution epidemiology, exploring the dynamic relationship between environmental and social/behavioral risk factors on cardiovascular disease. The additional training she will receive in social and behavior change methodologies will be essential for furthering the field of cookstove research and will uniquely provide her with the skills necessary to develop an independent research career focused on the development of these novel approaches to intervention research. Nearly 3 billion people rely on biomass combustion to meet basic domestic energy needs. Many households use traditional cookstoves to meet these energy needs, which can result in extremely high indoor air pollution concentrations. Indoor air pollution from biomass combustion accounts for an estimated 1.6 million premature deaths per year, representing about 3% of the global disease burden. Improved stove designs have the potential to substantially reduce indoor air pollution exposures. However, there are few randomized intervention trials, and previous stove intervention studies have been plagued by low improved stove adoption and sustained use, severely limiting interpretations of these studies. This research proposes to conduct community surveys and in-depth interviews among Honduran cookstove users to gain insight into the complex pathways surrounding barriers to and predictors of sustained improved cookstove adoption (Aim 1, K99-phase, among the target population for the proposed intervention in Aims 2-3). This information will be used to conduct and enhance a randomized improved cookstove intervention among 300 Honduran families, incorporating qualitative and quantitative measures of cookstove use and measuring pre- to post-intervention changes in pollutant exposures and subclinical indicators of cardiovascular health (Aims 2-3, R00-phase). The primary goals are twofold: to incorporate Community-Based Participatory Research (CBPR) approaches throughout all aspects of the research and to maximize sustained stove use (thereby maximizing the health impact of the intervention) to achieve valid exposure-response estimates. Both objectives utilize innovative strategies to fill knowledge gaps. The Candidate will have the extensive support of a mentoring and research team with expertise in air pollution epidemiology, exposure assessment techniques, and community- based approaches to conduct research. The research team will build upon previous studies in Latin America that have focused on identifying and validating appropriate field techniques for exposure and health assessments in rural areas of developing countries. The Candidate's post-doctoral research conducting a multiyear stove intervention in Nicaragua and doctoral research experience conducting a cross-sectional cookstove study in Honduras is directly relevant to the proposed project. Over the past 8 years, the Candidate and mentoring team have worked closely and successfully with the community partners (Trees, Water & People [TWP], Fort Collins, CO;AHDESA, Tegucigalpa, Honduras). Additionally, a new relationship with the Honduran academic partner (Zamorano Univeristy, Tegucigalpua, Honduras), who has an ongoing and productive relationship with TWP and AHDESA, has been cultivated. These partners will form the proposed Community and Academic Advisory Board to further develop the methods and conduct of the research plan. In summary, the proposed training and research plan is a logical follow-up to the research team's previous cookstove studies conducted in Latin America. It will provide insight regarding barriers/predictors of sustained cookstove adoption, an issue impeding research in this field;assess the relationship between stove use and indicators of cardiovascular health, a substantial and quickly growing disease burden in developing countries; result in a more comprehensive and valid assessment of the impact of a cookstove intervention;and provide the Candidate with the tools necessary to develop a vibrant independent research career, impacting the field of air pollution epidemiology by conducting research integrating the dynamic relationship between the physical and the social environment.
/ Relevance Approximately 3 billion people rely on solid fuel combustion to meet basic domestic energy needs. Many households use inefficient and poorly vented indoor cookstoves to meet these energy needs, leading to extremely high indoor air pollution levels and accounting for approximately 1.6 million premature deaths each year worldwide. The proposed work will be conducted within the framework of community-based participatory research and will examine the impact of an improved indoor cookstove intervention on changes in exposure and cardiovascular health in a developing country while employing methods to enhance adoption and sustained use of the new stove.