Evaluation of health risks associated with exposure to volatile organic compounds from household fuel combustion in southern India

Volatile organic compounds (VOCs) from household cook-fuel use are a major public health concern in low and middle income countries (LMICs), but health risk assessments have largely been based on measurements of fine particulate matter. We report results from cooking period measurements of 21 non-methane VOCs (NMVOCs) and estimated lifetime cancer risk for women cooks in the Tamil Nadu Air Pollution and Health Effects (TAPHE) cohort in Southern India. We enrolled 112 (56 biomass, 23 kerosene and 33 liquefied petroleum gas (LPG) using) TAPHE households to perform kitchen area measurements during the cooking period. VOC samples were collected on mixed-bed sorbent thermal desorption tubes using low-volume air samplers and analyzed using automated thermal desorption on a GC-MS system. Pentafluorobenzene, 1,4-difluorobenzene and chlorobenzene-d5 were used as internal standards that provided recoveries ranging from 81.7% to 119.9%. Total VOC concentrations were 4617 µg/m3, 2839 µg/m3 and 1639 µg/m3 while total BTEXS (i.e. benzene, toluene, ethylbenzene, m,p-xylene, o-xylene and styrene) concentrations were 139 µg/m3,121 µg/m3 and 245 µg/m3 among biomass, LPG and kerosene using households, respectively. Sampling season, type of food cooked and kitchen ventilation were significantly associated with measured total NMVOC concentrations. Lifetime cancer risks were estimated to be 2.93 × 10−3, 1.55 × 10−4 and 8.18 × 10−5, for biomass, kerosene and LPG fuel users, respectively with 1,2,3-trichloropropane, benzene, 1,4-dichlorobenze, 1,2-dibromoethane and chloroform contributing maximally to excess cancer risks. Health risk assessments for women cooks in LMICs should be expanded to include NMVOCs as these risks may not be adequately addressed through measurements of fine particulate matter (PM2.5) pollution alone

Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

Introduction Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda.Methods Using the Capability, Opportunity, Motivation–Behaviour (COM–B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial.Results We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits.Conclusion Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.Trial registration number NCT02944682, Pre-results