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A rural community intervention targeting biomass combustion sources: effects on air quality and reporting of children's respiratory outcomes
  1. Curtis W Noonan1,
  2. Tony J Ward1,
  3. William Navidi2,
  4. Lianne Sheppard3
  1. 1Center for Environmental Health Sciences, Department of Biomedical Sciences, The University of Montana, Missoula, Montana, USA
  2. 2Department of Mathematical and Computer Sciences, Colorado School of Mines, Golden, Colorado, USA
  3. 3Department of Biostatistics and Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, DC, USA
  1. Correspondence to Professor Curtis W Noonan, Center for Environmental Health Sciences, Department of Biomedical Sciences, 32 Campus Drive, The University of Montana, Missoula, Montana 59812, USA; curtis.noonan{at}


Objective Improvements in urban air quality are largely driven by controls on industrial and mobile source emissions, but such factors may have limited influence on many rural environments where biomass combustion (eg, wood stoves) serves as the primary source of fine particulate matter (PM2.5). The authors tracked changes in children's respiratory health during a wood stove intervention in a rural mountain valley community heavily impacted by wood smoke-derived PM2.5.

Methods Community-wide impacts on children's health were assessed by prospectively collecting surveys from parents of school children during four winter periods in Libby, Montana. Generalised estimating equations with a logit link were used to estimate the effect of reduction in ambient PM2.5 on wheeze prevalence and other reported symptoms and infections.

Results Over 1100 wood stoves were replaced with new lower emission wood stoves or other heating sources. Ambient PM2.5 was 27.6% lower in the winters following the changeout programme compared with baseline winters. There was a 26.7% (95% CI 3.0% to 44.6%) reduced odds of reported wheeze for a 5 μg/m3 decrease in average winter PM2.5. Lower ambient PM2.5 was also associated with reduced odds for reported respiratory infections, including cold (25.4% (95% CI 7.6% to 39.7%)), bronchitis (54.6% (95% CI 24.2% to 72.8%)), influenza (52.3% (95% CI 42.5% to 60.5%)) and throat infection (45.1% (95% CI 29.0% to 57.6%)).

Conclusion This wood stove intervention provided a unique opportunity to prospectively observe health benefits resulting from a targeted air pollution reduction strategy in a rural community.

  • Asthma
  • respiratory infections
  • biomass smoke
  • wood stove
  • epidemiology
  • air pollution
  • statistics

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  • Funding Funding was provided by Health Effects Institute (#4743-RFA04-4/06-4) and National Center for Research Resources (NCRR) (COBRE P20RR017670).

  • Competing interests None.

  • Ethics approval Ethics approval was approved by University of Montana Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will be made available per the requirements and procedures of the funding agency, Health Effects Institute.