The effects of biomass smoke exposure on blood pressure among adult women and children in the United States and China

This dissertation investigates the association between biomass smoke exposure and blood pressure (BP) among adults and children in China and the United States. Over half the world's population is exposed to airborne particulate matter (PM) from biomass combustion for household energy or burning tobacco during active smoking. Limited evidence suggests that PM from biomass combustion may be associated with elevated BP, an important risk factor for renal and cardiovascular disease morbidity and mortality.;In the first paper, I use field-collected data to quantify personal PM exposure among women and children living in rural Chinese households using biomass fuels. Our findings suggest that reducing overall PM exposure in this population may be best achieved by reducing winter exposure and, further, that behavioral interventions such as increasing ventilation during cooking or encouraging cookstove maintenance may help achieve these reductions.;Next, I built upon the PM exposure assessment and examined the relationship between personal PM exposure and BP. We found that PM exposure was independently and significantly associated with higher systolic (SBP) and diastolic blood pressure (DBP) in women over 50 years old. Among children, we found some evidence of a lower BP with higher PM exposure, however these results were not robust to models accounting for day-to-day exposure variation.;In the final paper, I studied effects of environmental tobacco smoke (ETS) exposure on BP in a cohort of U.S. children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES). We found ETS exposure was independently and significantly associated with higher SBP among boys and, conversely, significantly lower SBP among girls. We did not find a consistent relationship between ETS exposure and DBP for boys or girls.;This dissertation provides further evidence that cardiovascular disease may be an additional component of the global disease burden attributable to indoor biomass smoke. Our results show that exposure to PM from burning tobacco and fuelwood may pose a serious health risk for adults and children. Prioritizing issues of energy and indoor air pollution may be an important policy measure for both developed and developing countries as they try to reduce their cardiovascular disease burden.