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Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study

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Abstract

Residential wood burning has both practical and traditional values among many indigenous communities of the US Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial, we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n = 49), Filter (n = 47), and Control (n = 47) arms. Blood pressure and spirometry measures were collected multiple times during a pre-intervention winter period and during a follow-up post-intervention winter period. Despite strong PM2.5 exposure reduction results with the Filter arm (50% lower compared to Control arm), neither this intervention nor the Education intervention translated to improvements in the selected health measures among this population with a mixture of chronic conditions. Intention to treat analysis failed to demonstrate evidence that either of the intervention arms had beneficial effects on the blood pressure or the spirometry measures. Post hoc evaluation of effect modification for blood pressure and spirometry outcomes did not reveal any interaction influence on the outcomes according to sex, residential smoking, chronic disease history, and study area.

ClinicalTrials.gov: NCT02240069.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the many families that chose to participate in the EldersAIR study. The project also benefited from the strong support of community members and local research assistants from all study locations.

Funding

The study was funded by the National Institute of Environmental Health Sciences (NIEHS, 1R01ES022583). Intervention design was co-developed for the KidsAIR study (NIEHS, 1R01ES022649). Support was also provided by Center for Population Health Research (NIGMS, 1P20GM130418).

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Authors and Affiliations

  1. Center for Population Health Research, University of Montana, Missoula, MT, USA

    Curtis W. Noonan, Ethan S. Walker, Erin O. Semmens, Jon Graham, Paul Smith, Desirae Ware, Emily Weiler & Tony J. Ward

  2. School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA

    Curtis W. Noonan, Ethan S. Walker, Erin O. Semmens, Annie Belcourt, Paul Smith, Desirae Ware, Emily Weiler & Tony J. Ward

  3. Nez Perce Tribe Air Quality Program, Lapwai, ID, USA

    Johna Boulafentis & Julie Simpson

  4. Nimiipuu Health, Lapwai, ID, USA

    Crissy Garcia

  5. Navajo Nation Environmental Protection Agency, Window Rock, AZ, USA

    Nolan Hoskie & Eugenia Quintana

  6. Nez Perce Tribe Forestry and Fire Management Division, Lapwai, ID, USA

    Howard L. Teasley Jr

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  1. Curtis W. Noonan
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  2. Ethan S. Walker
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  3. Erin O. Semmens
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  4. Annie Belcourt
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  5. Johna Boulafentis
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  8. Nolan Hoskie
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  9. Eugenia Quintana
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  10. Julie Simpson
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  14. Emily Weiler
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  15. Tony J. Ward
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Contributions

CWN, TJW, and AB are the co-principal investigators and co-coordinators of the study. ESW conducted statistical analyses, and JG contributed to the statistical methods. CWN, TJW, JB, HT, EOS, AB, EW, and DW contributed to the study concept and design, revised the manuscript for important intellectual content, and approved the final manuscript. PS contributed to the health outcome protocols and provided medical record reviews. NH and EQ oversaw the Navajo Nation component of the study. JB and CG oversaw the Nez Perce Tribe component of the study. All authors reviewed and edited the manuscript to its final version.

Corresponding author

Correspondence to Curtis W. Noonan.

Ethics declarations

Ethics approval

The EldersAIR study was approved by the University of Montana IRB, the Navajo Nation Human Research Review Board, and the Nez Perce Tribal Executive Committee.

Consent to participate

Participants provided written informed consent prior to participation in the study. Participants were compensated for the time they spent performing study tasks and reimbursed for the cost of electricity when using the air filtration units within their homes.

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The authors declare that they agree with the publication of this paper in this journal.

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The authors declare no competing interests.

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Noonan, C.W., Walker, E.S., Semmens, E.O. et al. Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study. Air Qual Atmos Health (2024). https://doi.org/10.1007/s11869-023-01492-0

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