John Volckens - US grants

[unreadable] DESCRIPTION (provided by applicant): [unreadable] The candidate's overall career goal is to become a leading, independent researcher in the field of air pollution and air pollution effects on public health. Career objectives related to this grant are to: a) enhance the candidate's knowledge of pulmonary biochemistry and physiology, b) develop technical expertise in cellular toxicology, and c) develop an independent research program that integrates the fields of mechanistic toxicology with air pollution physics and exposure assessment. The long term goal of this research is to establish mechanistic, dose-response relationships between inhaled air pollutants and lung disease. Merging the fields of in vitro toxicology and exposure assessment is a necessary step in realizing this goal. Therefore, the immediate objective is to develop a realistic, physiological model for air pollutant deposition in vitro. The investigator's model will accomplish this task by approximating particle size-specific deposition patterns of particulate aerosols to pulmonary epithelial cells housed within a state-of-the-art in vitro lung model. This model will be developed, calibrated, and finally validated against the existing state-of-the-art model. [unreadable] [unreadable] In vitro toxicology can be employed as a relatively low-cost, rapid screening method for elucidating these mechanisms across many cell types. Establishing a link between exposure and health effect 1) provides a means for further innovations in the prevention and treatment of pulmonary disease, specifically allowing for more targeted (and resource-intensive) in vivo experimentation to follow from in vitro screening tests, 2) allows for intervention and control strategies targeted to reduce specific toxic components of ambient air pollution, and 3) helps provide the necessary information for regulating agencies to set more protective, health-based standards. [unreadable] [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Elucidation of potential nanoparticle exposure-disease relationships requires the development of an adequate exposure assessment method, as exposure assessment provides key input into subsequent epidemiologic and toxicological investigation. The absence of a personal exposure assessment method for nanoparticle aerosols prevents progress towards understanding potential nanoparticle exposure-disease relationships. The goal of this work is to develop an accurate, sensitive, and specific method to assess personal exposures to engineered nanoparticles. The method will assess the inhalation route of exposure, and hence, the measurement of nanoparticle concentrations in air. To quantify concentrations of airborne nanoparticles, a measurement must be able to segregate the aerosol by size (to capture only particles smaller than 100 nm) and count these particles following size-segregation. Also, because inhaled nanoparticles enter strictly through the oral/nasal route, the method should be oriented to measure breathing zone concentrations within the vicinity of the upper torso. Finally, and perhaps most importantly, the method must be able to distinguish engineered nanoparticles from other incidental nanoparticles (i.e., ultrafine particles) that are ubiquitous in workplace and ambient air. Relevance Successful completion of this research will establish a method to estimate human exposures to engineered nanoparticles in workplace environments. Such a method is critical to the establishment of nanoparticle dose- response relationships, as current methods lack both specificity and sensitivity. Results from this research can also be translated to the larger realm of health-related air pollution outside of the workplace (e.g., indoor air, ambient air pollution), both nationally and internationally.

DESCRIPTION (provided by applicant): The goal of this project is to develop novel sensing chemistry to rapidly assess the ability of freshly collected atmospheric aerosols to cause oxidative stress in biological systems. We propose to design and validate of a novel sensor for oxidative load that combines advantageous aspects of microfluidics with a new aerosol collection system. We hypothesize that measurement of direct and indirect oxidative load from freshly collected aerosol particles can be achieved using a microfluidic sensor coupled to an aerosol particle collector. Our approach is to replace traditional measurement instrumentation (filter collection with chromatography/spectroscopy) that is bulky, expensive, and slow with sensing systems utilizing microfluidics that are compact, fast, and inexpensive. Microfluidics provides the ability to carry out the chemical reactions necessary to determine oxidative load without repeated manual steps and provide the analytics to measure the resulting signals using microliter solution volumes. This reduction in solution volume allows a dramatic reduction in sampling and analysis time while still generating a measurable signal. The small size of the microfluidic system will also allow a portable sensor to be created, with the potential for personalized exposure assessment. At the same time we measure the reactivity of these aerosols, we will use on-line aerosol mass spectrometry to provide additional information on the relationship between oxidative load and the composition, size, and age of atmospheric aerosol. The aims of this project are: Specific Aim 1: Design, build, and test a microfluidic sensor coupled to a particle collector for measurement of aerosol oxidative load. In this design-focused aim, we will create the new sensing chemistry required for measurement of direct and indirect oxidative load. We will also evaluate analytic limits of detection and quantification under controlled laboratory conditions. Specific Aim 2: Measure the direct and indirect oxidative loads of freshly collected atmospheric aerosols. In the second aim we will test our central hypothesis, the ability to measure oxidative load of freshly deposited aerosol particles. We will also evaluate aspects of method sensitivity and specificity using alternative, off-line chemical analyses. PUBLIC HEALTH RELEVANCE: An emerging hypothesis states that aerosols cause a majority of their harmful effects by eliciting cellular oxidative stress. Consequently, there is a need for advancement in the field of oxidative stress measurement related to environmental agents. A novel on-line monitoring tool that provides a more physiologically relevant measure of air pollution properties that correlate with human disease will support benchside, sub-clinical, nd population-level studies that seek to associate oxidative air pollution with human disease. Thus, this instrumentation will help researchers and policymakers better understand the sources and mechanisms by which air pollution induces adverse health outcomes in both healthy and at-risk populations.

Summary/Abstract The primary objective of this research is to develop new technology to characterize personal exposure to airborne metals in the workplace. The secondary objective is to improve upon the state-of-the-art in both sensitivity and time-resolution of airborne metals exposure assessment. Key to this effort is an innovative technology called microfluidic paper analytical devices (¿PADs) that integrate sampling with analysis in a low cost, high sensitivity format. Our central hypothesis is that ¿PADs can be integrated into personal aerosol samplers for quantification of personal exposure to airborne metals with sampling and analysis times of less than one hour. To test this hypothesis, we propose the following specific aims: (1) Construct a single-analyte microfluidic paper analytical device (¿PAD) for metal analysis that is compatible with existing, size-selective personal aerosol samplers; (2) Construct a multi-analyte ¿PAD for analysis of Pb, Cu, Mn, and Ni concentrations in air; (3) Validate the performance of the multi-analyte ¿PAD in the field. Successful completion of the above aims will provide industrial hygienists with a sensitive, in-situ technique to assess airborne metal hazards in the workplace. Such technology represents a paradigm shift in the field of exposure assessment, as it has the potential to replace the traditional practice of sample shipment and laboratory analysis (both of which are time and resource intensive) with a direct, field analysis technique with improved sensitivity and time-resolution. This research contributes to the National Occupational Research Agenda (NORA) by developing a new and inexpensive instrumentation (a cross-sector theme) for assessing worker exposure (a cross-sector theme) to airborne metals (affecting the transportation/utilities, manufacturing, and construction sectors). Chemical analysis of a ¿PAD sample is expected to be at least an order of magnitude less expensive (around 5$ per sample) than analysis with traditional ICP-MS or AES techniques. Furthermore, integrating the ¿PAD into existing aerosol sampling devices (i.e., inhalable filter samplers) will enhance its acceptance by practicing occupational health professionals. This technology may open the door to a new realm of aerosol exposure assessment, as ¿PADs can be adapted to detect and quantify many metal, organic, or inorganic compounds.

DESCRIPTION (provided by applicant): Inhalable aerosols hazards are a significant contributor to the burden of occupational respiratory disease in this country. They are present in virtually every NORA sector: organic dusts in agriculture, forestry, and fishing; carbonaceous and mineral dusts in construction; metal and metalworking fluid aerosols in manufacturing; and coal dust in mining are but a few examples. However, we currently lack the technology to determine the size distribution of inhalable aerosol hazards in the workplace. Without this information, our ability to associate risk with exposure to inhalable aerosols is severely hampered. Therefore, the objective of this research is to develop new, inexpensive technology to characterize the size distribution of inhalable aerosol hazards in the workplace. Such a sampler will enable occupational health professionals to assess inhalable aerosol hazards more fully, as no commercially-available technologies currently exist to meet this need. The project has three specific aims: (1) Design an inexpensive, upflow clarifier to characterize the size distribution of inhalable aerosol hazards in the workplace (ranging from 10 to 100 5m); (2) Evaluate device performance using a combination of calm-air chamber studies and low-velocity wind tunnel experiments; (3) Test sampler performance in the field by characterizing inhalable particle size distributions for organic dust hazards in dairy and grain handling facilities. We will quantify inhalable organic dust size distributions as a function of mass and endotoxin content. The latter measure has never before been reported as a function of particle size for particles larger than 10 5m. This research contributes to the aims of the NORA by developing an exposure assessment technique capable of generating new and important knowledge for the field. Although inhalable aerosol samplers exist for measuring the total concentration of particles, we currently have no means for determining inhalable particle size distributions. Because size (in conjunction with chemical composition) plays a primary role in determining health effects, knowledge of the size-resolved chemical composition is of great interest to industrial hygienists, occupational physicians, and epidemiologists alike. PUBLIC HEALTH RELEVANCE: Occupational exposure to inhalable aerosols is a significant risk factor for many types of occupational respiratory disease. However, our ability to characterize these hazards is limited. This research, therefore, will develop improved technology with which to evaluate and help mitigate inhalable aerosol hazards in the workplace.

DESCRIPTION (provided by applicant): This work proposes to develop and test the performance of a low-cost, easy to use, disposable sampler to measure personal exposures to inhalable aerosols in the workplace. To improve the likelihood of future adoption by exposure assessors, the sampler will incorporate a redesign of the inlet cap of the 37-mm sampling cassette, the most commonly used particle sampler in the U.S. The sampler inlet will be designed to sample large particles with efficiency to match the international performance criterion for inhalable aerosol sampling. As such, the sampler will capture particles with the same efficiency as a worker's mouth and nose. This research will: (a) use computational fluid dynamics modeling tools to investigate how inlet geometries affect sampling efficiency, to optimize the sampler inlet, and to estimate an orientation-averaged sampling efficiency for the prototype sampler(s) to compare to the inhalable criterion; (b) investigate the sampling efficiency of the prototype sampler in a low-velocity wind tunnel and a calm-air chamber to quantify accuracy, precision, linearity, and internal losses, in controlled environments; and (c) field test and validate the sampler performance in three manufacturing settings and compare the sampling efficiencies to existing devices. Within the third aim, one of the worksites will examine both exposure and indicators of respiratory inflammation in the workers to examine whether exposures measured with the new inhalable sampler improve the measurements of association of health outcomes. This project addresses multiple NORA sectors (construction, manufacturing, refining, mining, and agriculture) as well as NORA Exposure Assessment cross-sector goals, including developing/improving methods to assess worker exposures to critical occupational agents and validation of these methods to provide and characterize their performance. The long-term outcome of this project includes the advancement of tools to improve exposure assessment evaluations. By increasing the adoption of physiologically-relevant exposure assessment tools, data-driven risk-based exposure limits for hazardous aerosols can be improved to protect worker health.

DESCRIPTION (provided by applicant): Motor vehicles emit a complex mixture of toxic chemicals that contributes substantially to the burden of air pollution exposure in this country. While a consistent link between ambient air pollution and cardiopulmonary effects has been demonstrated, very little knowledge exists regarding exposures and health effects of traffic- related air pollution specifically during the commute. Even in communities with low background levels of air pollution, there are intense, short-term exposures during commutes that may contribute to adverse health effects. Healthy, exercising populations (such as cyclists) have been neglected in previous air pollution research. Such populations with activities that increase lung dose are a potentially vulnerable subgroup among commuters. Therefore, a need exists to improve our understanding of the interactions between sources, exposures, and health effects of traffic-related air pollution. The objective of this research is to apply innovative modeling and exposure assessment and modeling techniques to improve our understanding of the impact of traffic-related air pollution on human exposure and health. To achieve this objective we propose the following specific aims: (1) Conduct a two-year study of commuters' personal exposures to traffic-related air pollution among different modes (car, bike) and routes (high- and low-traffic); (2) Develop and evaluate an exposure modeling system that integrates mechanistic air pollution fate and transport modeling, path-following exposure estimation, and Bayesian updating; and (3) Evaluate the short-term association of personal exposure levels during morning commutes with subclinical respiratory and cardiovascular responses that are central to the hypothesized biologic pathway linking air pollution with cardiovascular events. We hypothesize that personal exposures to traffic-related air pollution will be significantly higher for cyclists (vs. car drivers) and on high-traffic routes (vs. low-traffic), and that our model system will successfully predict average cumulative exposures for commuters traveling different route/mode combinations. We also hypothesize that increased personal exposure to traffic-related air pollution experienced during a commute will be associated with acute increases (from pre- to post-commute) in cardiovascular and respiratory responses. This project addresses knowledge gaps on the exposures and related health effects of a source of air pollution that affects the majority of the U.S. population. Given the emerging evidence on the adverse effects of traffic- related air pollution, information gained from this study can empower citizens to reduce their daily exposures to traffic-related air pollution. The daily commute, whether by bicycle, motor vehicle, or other mode, is an experience shared by nearly all Americans. Although ambient air pollution is generally considered a ubiquitous, involuntary hazard, research that develops new knowledge to reduce exposures to traffic-related air pollution during commuting has the potential to produce a substantial public health impact.

DESCRIPTION (provided by applicant): Approximately three billion people use traditional, inefficient and poorly vented indoor cookstoves to meet basic energy needs. Exposure to air pollutant emissions from these cookstoves, experienced primarily by the world's poorest people, accounts for 4.5% of the global burden of disease. This form of combustion is also the second leading source of light-absorbing carbon in the atmosphere. To address this problem, one focus has been to develop solid-fuel combustion technologies (i.e., improved or cleaner-burning stoves) that are more fuel efficient, affordable, and less polluting. The design and dissemination of cleaner stove technologies could have the single largest benefit to human and environmental health since the emergence of distributed water/sanitation systems in the previous century. The prevailing hypothesis is that any cleaner-burning stove (relative to traditional, open fires) will improve health; however, this hypothesis has not been rigorously tested. Improved stoves can vary widely in terms of pollutant emissions. This project, therefore, seeks to develop credible and representative laboratory data as a first step to test the improved stoves hypothesis and to improve our ability to address this massive threat to global health. We propose two specific aims. The first aim will develop a comprehensive profile of gaseous and particulate pollutants emitted from traditional and improved cookstoves. This aim will develop a more complete inventory of the toxic and climate-forcing pollutants emitted from residential cookstove combustion; these emissions are poorly understood and are likely different from well-characterized combustion sources (e.g., motor vehicles). This aim will provide more credible data for risk assessments and climate impact models, inform better stove design, and will aid our interpretation of health effects observed here (Aim 2) and in other studies. The emissions inventory will be made available online in an open-source format for use by researchers, policymakers, and other stakeholders. The second aim is to conduct a controlled human exposure study to investigate acute, subclinical effects of exposure to emissions from prevalent cookstove technologies. We will investigate markers of cardiorespiratory health (blood pressure, heart rate variability, augmentation index, exhaled nitric oxide, and markers of systemic inflammation, oxidative stress, coagulation, and platelet activation) in response to short-term exposures from five different stove types producing emissions that fall into various Tier categories promulgated by the International Standards Organization (ISO); several of the ISO Tier categories will result in air pollution concentrations that greatly exceed regulatory levels i the developed world. Thus, whether the introduction of improved stoves representing each of the Tiers within these newly-promulgated standards will produce meaningful health benefits is unclear. This is the first study to quantify the relationship between markers of cardiorespiratory health and exposure to a broad range of stove technologies. This research will inform future directions for stove programs while providing needed insight into the question, How clean is clean enough?

? DESCRIPTION (provided by applicant): Airborne chemical and biological hazards contribute substantially to our nation's occupational disease burden. And yet, the resources needed to monitor workforce exposure to these hazards are scarce. Ironically, while the cost of healthcare (and worker's compensation) is on the rise, both private and federal investment in industrial hygiene and workforce protection is on the decline. In the absence of (and bleak outlook for) renewed funding to ensure worker health, our field must strive to become dramatically more effective in light of diminishing resources. Therefore, a need exists to improve the efficiency, timeliness, and cost-effectiveness of workplace hazard surveillance. This project will develop and synergize innovative technologies to address that need. This project aims to advance the state-of-the-art in aerosol exposure measurement. Our field has relied for too long on an outdated, inefficient, and expensive paradigm that often leads to inadequate hazard surveillance. Our overarching hypothesis is that the high cost of air sampling/analysis is a limiting factor in our ability to protect worker health. These costs (literally hundreds of dollarsper measurement) preclude day-to-day industrial hygiene efforts, they limit regulatory enforcement, and they stifle the development of credible epidemiology; the latter, in turn, hinders our ability o develop new exposure guidelines (and interventions) that protect worker health. The objective of this work, therefore, is to develop personal air sampling and analysis technologies (pump, sampler, and in-field chemical assays) so that workplace air monitoring can become more cost-effective, timely, and representative. This research will develop technology that reduces the cost of workplace air monitoring by over an order of magnitude and the time from sampling to hazard communication from weeks to hours. As a result, this project has the potential to break a long-held paradigm of inefficient and expensive hazard surveillance. By enabling more efficient, low-cost monitoring, these technologies will allow occupational health researchers to survey hazards (and prevent disease) on a wider scale and across virtually every NORA sector. In the developing world, this technology could empower a rebirth of industrial hygiene in many developing (and very unsafe) industrial sectors.

DESCRIPTION (provided by applicant): Particulate matter (PM) air pollution is considered a top-10 contributor to (and the leading environmental risk factor for) the global burden of disease. To date, evidence on PM health effects has been gathered primarily from medium-to-large scale epidemiology studies, which have traditionally relied upon relatively crude measures of human exposure (i.e., fixed site sampling for PM mass with little to no PM composition analyses). As a result, these studies tend to emphasize the effects of PM on more sedentary populations (such as the elderly) and/or that live close to air monitoring sites. The field now recognizes that air pollution exposure is highly heterogeneous and that exposure measurement error substantially limits the linkage of exposures to specific pathologies. Recently, epidemiologic interest in mobile populations (e.g., school-aged children or working adults) has increased and the exposure assessment field has shifted towards measures and models of personal exposure to specific PM chemical constituents (and PM properties) suspected to drive human morbidity and mortality. Unfortunately existing technologies for both sampling and analysis are limited by cost, and usability. Thus, a need exists for personal PM sensors that are inexpensive, wearable (with low-burden), yet still highly sensitive and capable of measuring specific PM properties. Our team has developed technology that meets these needs: a small, portable, inexpensive micro environmental sampler and a low cost sensing chemistry that can quantify PM chemical composition both quickly and cost-effectively. During this project, we propose to 1) Evaluate and validate the sampling and analysis methods using laboratory, field, and limited personal exposure studies (R21 phase) and 2) Demonstrate performance and added scientific value through application in the Children's Health and Air Pollution in the San Joaquin Valley (CHAPS-SJV) study (R33 phase). In the first phase, we will demonstrate the usability of our technology by engaging multiple test populations (college students, 9-11 year olds in Fort Collins, CO and high school students in Fresno, CA). In the second phase, we will use the system to provide first of its kinds information on micro environmental exposures and PM composition as it relates to inflammation biomarkers for acute exposures. The resulting data will be used to improve models of air pollution exposure for children in the San Joaquin Valley with the long-term goal of improving the health of these children.

Project Summary Inhalation of metal particles poses a significant hazard in the workplace. The deleterious effects of particulate metal exposure at high concentrations have been well documented in the literature. Metals that are accepted as carcinogens include chromium, nickel, beryllium, cadmium, arsenic, and silicon. For other metals such as lead, titanium, iron, and cobalt, the association between exposure and cancer is less clear, although there are other adverse health effects. For example, epidemiological studies have documented significant associations between exposure to welding fumes and diseases such as pneumonia, sidrosis, and neurological disorders such as Parkinsonism. Exposure to beryllium, in particular, remains a significant occupational hazard since exposure to even small amounts is associated with beryllium sensitization which can lead to chronic beryllium disease. State-of-the-art sampling methods for particulate metals and inhalable particles rely on time-integrated filter samples which require laboratory analysis after sampling. Such measurements provide minimal temporal or spatial resolution of the exposure and are slow (days to weeks) and costly (typically several hundred for ICP- OES analysis per sample). Occupational exposure monitoring for particulate metals rarely occurs due to high cost and effort associated with exposure monitoring. Measurement capabilities for counting and sizing particles between 20 and 100 µm in real-time are limited. Instruments capable of real-time measurements of both chemical composition and particle size, as is needed to more fully understand health effects, are even more limited. There are two specific aims to this project. The first aim develops and integrates laser-induced breakdown spectroscopy (LIBS) into our existing particle sizing instrument, the Direct-Reading Inhalable Particle Sizer (DRIPS). This aim assesses the plasma characteristics, optimizes the triggering system and particle detection rate, and develops calibration curves. A field testable prototype real-time DRIPS with Elemental Composition Analyzer (DRIPS-ECA) will be built. The second aim evaluates the calibration curves in response to alloys and develops semi-empirical models to determine metal concentration. The second aim also compares the DRIPS- ECA performance to traditional filter samples (analyzed with SEM-EDS) in a field setting.

Abstract Comprehensive exposure assessment in the field of occupational health has been limited, historically, by a combination of technological, financial, and human factors. The cost and complexity of personal sampling technology limits a single industrial hygienist (IH) to making, at most, about 10 measurements of personal airborne exposure each day. Many hygienists can work together to produce a larger exposure dataset; however, the cost to assess exposures for every worker in a facility is exorbitant under the current paradigm. These limitations hinder our ability to identify workers at risk of overexposure; they also lead to imprecise effect estimates in occupational epidemiology. Collectively, these limitations lead to greater risks of poor health outcomes among workers. This project seeks to develop new technologic and methodologic approaches for assessing worker exposure to occupational air pollutants. We will develop a wearable exposure monitor for aerosol and vapor hazards that is immediately deployable ?out of the box? with minimal user training. Further, the monitor will be designed to take reference-quality measurements of tens to potentially hundreds of different airborne compounds. We also seek to transform the practice of industrial hygiene by further leveraging support and participation of the workers themselves through a citizen-science approach to hazard identification and exposure assessment. Successful completion of this research will enable dramatically greater sample sizes for personal exposure measurements in the workplace, which, in turn, will promote more better professional judgement, more efficient hazard control, more effective epidemiology, and improved worker health. A second goal is to demonstrate the potential for citizen science to improve worker comprehension of and engagement in workplace safety culture. The project has two aims. The first is to develop a simple, inexpensive, ?smart? sampling device for comprehensive assessment of personal exposures to aerosol and vapor hazards. The device will be small and easy to deploy and wear while containing quality-assurance features necessary to meet the performance of accepted standard reference methods (active flow control, fault monitoring, user compliance). The second aim is to conduct a series of field deployments to evaluate whether the new technology, when used with a citizen science approach, can promote better engagement in and knowledge of workplace health and safety among workers, organizations, and industrial hygienists. We hypothesize that the citizen-science approach will change worker- and organizational-level attitudes and behaviors relevant to occupational hazard assessment and mitigation. We also hypothesize that industrial hygienists will improve their ability to accurately assign workers to exposure control categories, when presented with the comprehensive exposure data we generate. Successful completion of this work will validate a new technology for workplace hazard assessment while demonstrating the utility of a citizen science approach to increase knowledge and awareness of health and safety in the workplace.

Abstract Exposure to household air pollution from the use of traditional energy sources is a top-ten risk factor for morbidity and mortality worldwide. Emissions from traditional energy sources in the home create unhealthy levels of household air pollution and the issue is pervasive. Approximately 3 billion people rely on fuels like wood, charcoal, and kerosene to support needs such as cooking, heating, and lighting. Approximately 80% of the population in Rwanda uses such fuels, making exposure to household air pollution the 3rd leading contributor to the burden of disease in this country. Exposure to household air pollution is also a problem in the developed world. Nearly 30 million Americans burn solid fuels as their primary source of heating energy. Nearly 50 years of research on ?cleaner? household energy technologies has demonstrated only modest global impact, due to a combination of economic, cultural, and technologic barriers that prevent access to and usage of clean energy. A further limitation is that nearly all household energy interventions, to date, have focused on replacing only a single energy source (i.e., replacing just cooking, or just lighting) with a more modern technology. We propose to address these issues by conducting a randomized controlled trial that (1) focuses on total household energy (2) in a country that evinces readiness for alternative forms of energy, (3) by forming a public- private partnership to promote technological solutions that are consumer-focused and market sustainable, (4) by investigating outcome measures that are clinically actionable and strongly linked to morbidity/mortality, and (5) by developing project outputs that can inform policymakers with cost-benefit information. We hypothesize that a whole-house energy intervention (replacing all primitive forms of energy within the home with cleaner, modern forms) will produce meaningful reductions in household air pollution and health benefits in rural Rwandan homes. The randomized controlled trial will substitute traditional forms of household energy (biomass for cooking and kerosene for lighting) with solar power and liquefied petroleum gas stoves in rural Rwanda. Participants will be followed for 3 years with repeated measurements of household air pollution exposure (24-hour fine particulate matter and black carbon), energy usage, and health. Primary health endpoints will include blood pressure in adult women and men and lung-function growth in children; secondary health endpoints include blood pressure in children and lung-function change in adults. The long-term goals of this research are to increase the clinical knowledge-base on the health effects on household air pollution, to demonstrate that a whole-house energy intervention will produce meaningful household air pollution reductions and health benefits in rural Rwandan homes, to elucidate the relationship between fuel subsidy levels and household air pollution exposure, and to demonstrate that scalable solutions to the household air pollution disease burden are achievable via public-private-governmental partnerships.