Seasonal variation in outdoor, indoor, and personal air pollution exposures of women using wood stoves in the Tibetan Plateau: Baseline assessment for an energy intervention study

Cooking and heating with coal and biomass is the main source of household air pollution in China and a leading contributor to disease burden. As part of a baseline assessment for a household energy intervention program, we enrolled 205 adult women cooking with biomass fuels in Sichuan, China and measured their 48-h personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO) in winter and summer. We also measured the indoor 48-h PM2.5 concentrations in their homes and conducted outdoor PM2.5 measurements during 101 (74) days in summer (winter). Indoor concentrations of CO and nitrogen oxides (NO, NO2) were measured over 48-h in a subset of ~80 homes. Women's geometric mean 48-h exposure to PM2.5 was 80μg/m(3) (95% CI: 74, 87) in summer and twice as high in winter (169μg/m(3) (95% CI: 150, 190), with similar seasonal trends for indoor PM2.5 concentrations (winter: 252μg/m(3); 95% CI: 215, 295; summer: 101μg/m(3); 95% CI: 91, 112). We found a moderately strong relationship between indoor PM2.5 and CO (r=0.60, 95% CI: 0.46, 0.72), and a weak correlation between personal PM2.5 and CO (r=0.41, 95% CI: -0.02, 0.71). NO2/NO ratios were higher in summer (range: 0.01 to 0.68) than in winter (range: 0 to 0.11), suggesting outdoor formation of NO2 via reaction of NO with ozone is a more important source of NO2 than biomass combustion indoors. The predictors of women's personal exposure to PM2.5 differed by season. In winter, our results show that primary heating with a low-polluting fuel (i.e., electric stove or wood-charcoal) and more frequent kitchen ventilation could reduce personal PM2.5 exposures. In summer, primary use of a gaseous fuel or electricity for cooking and reducing exposure to outdoor PM2.5 would likely have the greatest impacts on personal PM2.5 exposure.