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      Who Adopts Improved Fuels and Cookstoves? A Systematic Review

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          Abstract

          Background: The global focus on improved cookstoves (ICSs) and clean fuels has increased because of their potential for delivering triple dividends: household health, local environmental quality, and regional climate benefits. However, ICS and clean fuel dissemination programs have met with low rates of adoption.

          Objectives: We reviewed empirical studies on ICSs and fuel choice to describe the literature, examine determinants of fuel and stove choice, and identify knowledge gaps.

          Methods: We conducted a systematic review of the literature on the adoption of ICSs or cleaner fuels by households in developing countries. Results are synthesized through a simple vote-counting meta-analysis.

          Results: We identified 32 research studies that reported 146 separate regression analyses of ICS adoption (11 analyses) or fuel choice (135 analyses) from Asia (60%), Africa (27%), and Latin America (19%). Most studies apply multivariate regression methods to consider 7–13 determinants of choice. Income, education, and urban location were positively associated with adoption in most but not all studies. However, the influence of fuel availability and prices, household size and composition, and sex is unclear. Potentially important drivers such as credit, supply-chain strengthening, and social marketing have been ignored.

          Conclusions: Adoption studies of ICSs or clean energy are scarce, scattered, and of differential quality, even though global distribution programs are quickly expanding. Future research should examine an expanded set of contextual variables to improve implementation of stove programs that can realize the “win-win-win” of health, local environmental quality, and climate associated with these technologies.

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          Most cited references56

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          Global and regional climate changes due to black carbon

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            Indoor air pollution in developing countries: a major environmental and public health challenge.

            Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.
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              Public health benefits of strategies to reduce greenhouse-gas emissions: health implications of short-lived greenhouse pollutants.

              In this report we review the health effects of three short-lived greenhouse pollutants-black carbon, ozone, and sulphates. We undertook new meta-analyses of existing time-series studies and an analysis of a cohort of 352,000 people in 66 US cities during 18 years of follow-up. This cohort study provides estimates of mortality effects from long-term exposure to elemental carbon, an indicator of black carbon mass, and evidence that ozone exerts an independent risk of mortality. Associations among these pollutants make drawing conclusions about their individual health effects difficult at present, but sulphate seems to have the most robust effects in multiple-pollutant models. Generally, the toxicology of the pure compounds and their epidemiology diverge because atmospheric black carbon, ozone, and sulphate are associated and could interact with related toxic species. Although sulphate is a cooling agent, black carbon and ozone could together exert nearly half as much global warming as carbon dioxide. The complexity of these health and climate effects needs to be recognised in mitigation policies. Copyright 2009 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                01 February 2012
                May 2012
                : 120
                : 5
                : 637-645
                Affiliations
                [1 ]Nicholas School of the Environment,
                [2 ]Sanford School of Public Policy, and
                [3 ]Global Health Institute, Duke University, Durham, North Carolina, USA
                Author notes
                Address correspondence to S.K. Pattanayak, Duke University, P.O. Box 90312, Durham, NC 27708-0312 USA. Telephone: (919) 613-9306. Fax: (919) 684-9940. E-mail: subhrendu.pattanayak@ 123456duke.edu
                Article
                ehp.1104194
                10.1289/ehp.1104194
                3346782
                22296719
                e0a07fcd-dffb-4f16-abdd-4d4e826cf0a3

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Review

                Public health
                fuel switching,fuel choice,improved cookstove,adoption regressions,indoor air pollution,systematic review

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