IntroductionHousehold energy transitions have the potential to reduce the burden of several health outcomes but have narrowly focused on those mediated by reduced exposure to air pollution, despite concerns about the burden of injury outcomes. Here, we aimed to describe the country-level incidence of severe cooking-related burns in Ghana and identify household-level risk factors for adults and children.MethodsWe conducted a national household energy use survey including 7389 households across 370 enumeration areas in Ghana in 2020. In each household, a pretested version of the Clean Cooking Alliance Burns Surveillance Module was administered to the primary cook. We computed incidence rates of severe cooking-related burns and conducted bivariate logistic regression to identify potential risk factors.ResultsWe documented 129 severe cooking-related burns that had occurred in the previous year. The incidence rate (95% CI) of cooking-related burns among working-age females was 17 (13 to 21) per 1000 person-years or 8.5 times higher than that of working-age males. Among adults, the odds of experiencing a cooking-related burn were 2.29 (95% CI 1.02 to 5.14) and 2.40 (95% CI 1.04 to 5.55) times higher among primary wood and charcoal users respectively compared with primary liquified petroleum gas users. No child burns were documented in households where liquified petroleum gas was primarily used.ConclusionUsing a nationally representative sample, we found that solid fuel use doubled the odds of cooking-related burns compared with liquified petroleum gas. Ghana’s efforts to expand access to liquified petroleum gas should focus on safe use.

This review examines government-sponsored environmental justice indices used in the United States, focusing on how their design choices operationalize justice. Rather than evaluating index outputs, we analyze their structural features, aggregation strategies, and underlying assumptions, and assess how they are used in peer-reviewed research between 2020 and 2025. Across jurisdictions, indices show strong structural convergence, typically including exposure and vulnerability domains. Additive and multiplicative aggregation approaches encode different assumptions about how burdens interact, affecting community rankings and designations. Despite growing policy influence, indices are infrequently used as primary analytical tools in research. Procedural and recognitional dimensions remain weakly represented, and index construction is rarely examined explicitly. Environmental justice indices function not only as measurement tools but as governance mechanisms shaping eligibility and resource allocation. While effective for distributive screening, they represent partial definitions of justice and should be interpreted with caution within broader democratic and community-based frameworks.

At the household level, energy powers human health and wellbeing, enabling essential services such as cooking, lighting, communications, heating, cooling, and ventilation. Despite the recognised need for reliable clean energy, access remains deeply unequal, with high-income households benefiting from modern energy sources while over 600 million people do not have access to electricity and 2-3 billion people rely on biomass fuels as an energy source to meet basic household needs. 2-3 million deaths annually are attributed to household air pollution (HAP) from the combustion of these fuels. HAP degrades ambient air quality and contributes to climate change. Studies of household energy and HAP largely focus on cooking-related emissions and might underestimate the true effect of energy use at home to meet a variety of needs, such as heating and lighting. This Series paper reviews the methods used to estimate the HAP disease burden, evaluates the current epidemiological evidence, and examines the health effects of interventions aimed at cleaner energy adoption. Despite differences in methodology, exposure assessment approaches, or the specific health outcomes considered, estimates of global deaths attributable to HAP exposure consistently remain in the millions each year. Thus, this Series paper also identifies areas for future research, emphasising the need for equitable access to clean energy, especially in low-income and middle-income countries.

Indoor nitrogen dioxide (NO _2 ) and fine particulate matter (PM _2.5 ) are concerns in U.S. households, especially those that cook using gas or propane stoves. Exposures to these and other indoor pollutants are linked to a variety of adverse health outcomes, including asthma morbidity, that disproportionately affect low-income households. We conducted a cross-sectional study of 138 homes in four low-income rural communities in California’s San Joaquin Valley, comparing air pollutant concentrations between households that participated in a state electrification program and households using propane or natural gas for cooking. In each home, pollutants were monitored for approximately one month using personal air monitors and for 48 h using reference-grade instruments. Median 48-h average indoor NO _2 concentrations were 63% lower in electric stove homes (electric: 6.0 ppb, gas: 16.0 ppb, p < 0.001). No electric stove homes had 48-h indoor NO _2 concentrations exceeding the California annual guideline of 30 ppb, while 17% of gas homes did. Additionally, no electric stove homes had 1-h rolling-average NO _2 concentrations exceeding the 100-ppb level deemed unhealthy for sensitive groups by the U.S. Environmental Protection Agency, whereas 41% of gas homes exceeded this threshold. PM _2.5 concentrations were similar across groups, indicating that cooking-related emissions from food were the dominant contributor to PM _2.5 mass concentrations rather than particles generated from gas combustion. Our evaluation of monitoring durations showed that two to four days of NO _2 data and one week of PM _2.5 data provided reliable estimates of longer-term averages, suggesting that shorter campaigns may yield robust estimates of indoor air quality. These results support the provision of electric cooking technologies as a strategy to address air quality-related health risks in rural, low-income communities and provide new evidence from an understudied population that can inform future indoor air quality research and energy transition policies.

Background: Utility services for electricity, gas, heat, and hot water are necessities for everyday activities (e.g., lighting, cooking, and thermal safety). Utility outages can threaten health; however, information is limited on the prevalence of electricity, gas, heat, and hot water outages in representative studies. We characterized infrastructure-related electricity, gas, heat, and hot water outages in New York City (NYC) and within subgroups. Methods: Using a representative 2022 survey of NYC adults (18+), we assessed the prevalence for 6+ hour utility outages and compared across building, demographic, and health subgroups. Building characteristics included age, number of floors, rental type, and owner/rental status. Demographics included household poverty, neighborhood poverty, and race/ethnicity. For health, we focused on cognitive impairment, electricity-dependent medical equipment use, and mental health conditions. Results: Outages impacted 20% of NYC residents. Heat outages were nearly 3× and 2× more common in mid-rise and high-rise buildings respectively, vs. low-rise buildings. Similarly, hot water outages were 5× and over 6× more prevalent in mid-rise and high-rise residences. Renters faced 2× more heat and hot water outages compared with owners. Compared with low-poverty households, high-poverty households faced 2× more hot water outages. Residents with mental health conditions experienced more electricity (11% vs. 5%), heat (15% vs. 7%), and hot water (16% vs. 8%) outages compared with those without. Conclusions: NYC utility outage prevalence varied by type with heat and hot water being most common. Disparities across building, sociodemographic, and health characteristics were also larger and more frequent for heat and hot water outages.

Adoption of electric stoves and rooftop solar can reduce fossil-fuel reliance and improve health by decreasing indoor air pollution and alleviating energy insecurity. This study assessed prevalence and perceptions of these clean-energy technologies to increase adoption in New York City (NYC). A representative survey of 1950 NYC adults was conducted from February 28 to April 1, 2022. Fourteen percent of people had an electric stove; 86% had gas stoves. Black, Latino/a, and lower-income residents were more likely to have electric stoves than White and higher-income residents. Only 14% of residents were interested in switching from gas to electric stoves. Of the 71% with gas stoves uninterested in switching, nearly half (45%) preferred gas cooking, particularly among White and higher-income residents, indicating a large opportunity to shift preferences. About 5% used solar for their home or building; another 77% were interested in solar. Of the 18% uninterested in solar, reasons included lack of agency, confusion about operation, and costs. Education about health and cost benefits, induction technology, how to transition, available subsidies, and other efforts to reduce adoption barriers can support clean technology uptake. Residential clean energy metrics should be tracked regularly to ensure that technology adoption proceeds equitably.

BACKGROUND:The association between prenatal household air pollution (HAP) exposure and childhood blood pressure (BP) is unknown. OBJECTIVE:Within the Ghana Randomized Air Pollution and Health Study (GRAPHS) we examined time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure with BP at 4 years of age and, separately, whether a stove intervention delivered prenatally and continued through the first year of life could improve BP at 4 years of age. METHODS:GRAPHS was a cluster-randomized cookstove intervention trial wherein n=1,414 pregnant women were randomized to one of two stove interventions: a) a liquefied petroleum gas (LPG) stove or improved biomass stove, or b) control (open fire cooking). Maternal HAP exposure over pregnancy and child HAP exposure over the first year of life was quantified by repeated carbon monoxide (CO) measurements; a subset of women (n=368) also performed one prenatal and one postnatal personal fine particulate matter (PM2.5) measurement. Systolic and diastolic BP (SBP and DBP) were measured in n=667 4-y-old children along with their PM2.5 exposure (n=692). We examined the effect of the intervention on resting BP z-scores. We also employed reverse distributed lag models to examine time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure and resting BP z-scores. Among those with PM2.5 measures, we examined associations between PM2.5 and resting BP z-scores. Sex-specific effects were considered. RESULTS:Intention-to-treat analyses identified that DBP z-score at 4 years of age was lower among children born in the LPG arm (LPG β=-0.20; 95% CI: -0.36, -0.03) as compared with those in the control arm, and females were most susceptible to the intervention. Higher CO exposure in late gestation was associated with higher SBP and DBP z-score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP z-score. In the subset with PM2.5 measurements, higher maternal postnatal PM2.5 exposure was associated with higher SBP z-scores. DISCUSSION:These findings suggest that prenatal and first-year-of-life HAP exposure are associated with child BP and support the need for reductions in exposure to HAP, with interventions such as cleaner cooking beginning in pregnancy. https://doi.org/10.1289/EHP13225.

As cities and states across the United States increasingly commit to building decarbonization, gas stoves are garnering public health attention because, in addition to contributing to greenhouse gas emissions, they may pose a respiratory health risk. Disadvantaged groups, as defined by demographic, socioeconomic, and residential factors, are often late adopters of new technology. To ensure that disadvantaged groups are not left behind from this transition, WE ACT for Environmental Justice, a New York City community-based environmental justice organization, implemented the first pilot of gas-to-electric stove transition in low-income housing. The goal of this mixed-methods study was to evaluate the effect of this intervention on indoor air quality and to characterize the distinct experiences of low-income residents. Twenty low-income households were recruited and randomized to an intervention (replacement of gas stove with induction stove) and a control arm. Between October 2021 and July 2022, three 168-hr long monitoring campaigns were conducted to assess indoor air quality (NO2, CO, and PM2.5) and stove use pre- and postintervention. The impact of cooking events on indoor air quality was further evaluated during controlled cooking tests carried out in both gas and induction homes. To identify key characteristics of the end-user experience throughout this intervention, participants were invited to join focus group discussions. Between baseline and endline, 168-hr average NO2 and CO concentrations decreased in both study arms, likely due to seasonality factors. Still, the induction arm showed a 56 % reduction (95 % CI: -61.9 %, -15.2 %) in mean daily NO2 concentration compared to the gas arm. During controlled cooking tests, the median background NO2 concentration (18 ppb) in gas homes rose to 197 ppb and negligibly changed in induction homes. During focus group discussions, participants unanimously reported being pleased with the transition and highlighted quality of life improvements resulting from the unexpected intervention's ability to address energy insecurity concerns. Taken together, our quantitative and qualitative results suggest that decarbonization energy transitions can improve health by reducing indoor NO2 but need to extend beyond single appliance swap-out to address health issues resulting from energy insecurity.

Clean-cooking transitions have the potential to generate large public health, environmental and societal gains for 2.6 billion people in the Global South. Here we use data from Ghana’s largest household energy survey ( n = 7,389) to provide two main insights. First, regression analysis of 13 commonly cited socio-economic and demographic determinants of household fuel use indicates remarkably different relationships with clean-fuel use at different stages of the transition process. We propose a stage-based transition framework that can help inform the rollout of clean-cooking interventions. Second, we identify factors that are associated with the exclusive use of liquefied petroleum gas (LPG) using a statistically powered sample of exclusive LPG users ( n = 693). We show that, all else equal, increases in wealth and urbanicity are not—contrary to conventional wisdom—associated with a transition from primary to exclusive LPG use. Whereas further research is needed to determine causality, our findings highlight the potential for more careful measurement, isolating each stage of the clean-cooking transition, to inform new insights and policy opportunities.

Over the last decades, air pollution emissions have decreased substantially; however, inequities in air pollution persist. We evaluate county-level racial/ethnic and socioeconomic disparities in emissions changes from six air pollution source sectors (industry [SO 2 ], energy [SO 2 , NO x ], agriculture [NH 3 ], commercial [NO x ], residential [particulate organic carbon], and on-road transportation [NO x ]) in the contiguous United States during the 40 years following the Clean Air Act (CAA) enactment (1970-2010). We calculate relative emission changes and examine the differential changes given county demographics using hierarchical nested models. The results show racial/ethnic disparities, particularly in the industry and energy generation source sectors. We also find that median family income is a driver of variation in relative emissions changes in all sectors—counties with median family income >$75 K vs. less generally experience larger relative declines in industry, energy, transportation, residential, and commercial-related emissions. Emissions from most air pollution source sectors have, on a national level, decreased following the United States CAA. In this work, we show that the relative reductions in emissions varied across racial/ethnic and socioeconomic groups.

The use of liquefied petroleum gas (LPG), a World Health Organization (WHO)-designated “clean” fuel, dominates household fuel expansion in low- and middle-income countries. This is due largely to support by the oil and gas industry, government policies, and claims of health and climate benefits over traditional biomass. However, recent randomized controlled trials, though confirming that switching from biomass to LPG cooking reduces exposure to air pollutants, have found little evidence of improved health outcomes. LPG offers reductions in greenhouse gas emissions compared to biomass, but its role as a by-product of fossil fuel production and its increasing use in the fossil fuel supply chain compromises the goal of universal access to sustainable energy. We propose a set of policies that the WHO, governments, funders, researchers, and non-governmental organizations can pursue to promote and assess alternative fuels as part of the continued effort to implement and ensure a clean, healthful, equitable, and sustainable energy future for all.

Air pollution is the fourth-highest risk factor for premature deaths globally and the second-highest risk factor for premature deaths in Ghana. Understanding the socioeconomic correlates of cooking stove/fuel choices and stove stacking patterns is a precursor to designing effective household air pollution interventions. The study applies the multinomial logit model (MNL) to identify socio-economic determinants of household cooking stoves in three unique analyses. In the first analysis, the study examines socio-economic determinants of primary stove choice for LPG, charcoal, and three-stone stoves. Secondly, the study examines determinants of stove choice for primary and secondary stoves when the order is not taken into account: LPG-charcoal, LPG-3-stone, and charcoal-3-stone. The third analysis examines determinants of stove use patterns among stove stackers when the order is taken into consideration: LPG-charcoal, LPG-3-stone, charcoal-3-stone, charcoal-LPG, 3-stone-LPG, and 3-stone-charcoal stove combinations. A cross-sectional design is used to collect data from sampled districts in all 16 regions of Ghana, covering about 7400 household-level respondents in 370 enumeration areas (EAs); across 177 urban EAs and 193 rural EAs. The results show that primary cooks with higher education, smaller, wealthier, and urban households are more likely to use LPG; more likely to use a stacking mix that includes LPG, and more likely to use a stacking combination where LPG is the primary stove-fuel used. Ghana is currently undertaking a National LPG Promotion Programme (NLPGPP) that seeks to increase LPG access by providing subsidized “starter kits” (stoves, regulators and cylinders) to periurban and rural households. Our findings can aid in targeting households effectively. Our results suggest that households that are female-headed; have less educated household heads; have household heads who double as the primary cook; have larger family sizes, have lower socio-economic status, and are rural, will have an increased probability of adopting and using a cleaner stack of cooking technologies and have an increased probability of using LPG long term, conditional on receiving a starter kit. Such a targeted intervention with a multifaceted approach to shifting households to a cleaner stack of cooking technologies could result in widespread adoption and contribute to significant reductions of CO and PM2.5 emissions in Ghana. A cleaner stack of cooking technologies, given the socio-demographics that are least likely to adopt and sustain use, will have a significant impact on health, the environment, and climate change.

ADVERTISEMENT RETURN TO ISSUEPREVCorrespondence/Rebut...Correspondence/RebuttalNEXTCorrespondence on "Home is Where the Pipeline Ends: Characterization of Volatile Organic Compounds Present in Natural Gas at the Point of the Residential End User"Misbath Daouda*Misbath DaoudaDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York 10032, United States*[email protected]More by Misbath Daoudahttps://orcid.org/0000-0003-2441-4227, Annie CarforoAnnie CarforoWE ACT for Environmental Justice, New York, New York 10031, United StatesMore by Annie Carforo, Darby JackDarby JackDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York 10032, United StatesMore by Darby Jack, and Diana HernándezDiana HernándezDepartment of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York 10032, United StatesMore by Diana HernándezCite this: Environ. Sci. Technol. 2023, 57, 4, 1848–1849Publication Date (Web):January 19, 2023Publication History Received13 December 2022Published online19 January 2023Published inissue 31 January 2023https://pubs.acs.org/doi/10.1021/acs.est.2c09423https://doi.org/10.1021/acs.est.2c09423article-commentaryACS PublicationsCopyright © 2023 American Chemical Society. This publication is available under these Terms of Use. Request reuse permissions This publication is free to access through this site. Learn MoreArticle Views1158Altmetric-Citations-LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail PDF (954 KB) Get e-AlertscloseSUBJECTS:Energy,Environmental chemistry,Environmental pollution,Natural resources,Volatile organic compounds Get e-Alerts

Purpose of Review The volume of public health environmental justice (EJ) research produced by academic institutions increased through 2022. However, the methods used for evaluating EJ in exposure science and epidemiologic studies have not been catalogued. Here, we completed a scoping review of EJ studies published in 19 environmental science and epidemiologic journals from 2018 to 2021 to summarize research types, frameworks, and methods. Recent Findings We identified 402 articles that included populations with health disparities as a part of EJ research question and met other inclusion criteria. Most studies (60%) evaluated EJ questions related to socioeconomic status (SES) or race/ethnicity. EJ studies took place in 69 countries, led by the US ( n = 246 [61%]). Only 50% of studies explicitly described a theoretical EJ framework in the background, methods, or discussion and just 10% explicitly stated a framework in all three sections. Among exposure studies, the most common area-level exposure was air pollution (40%), whereas chemicals predominated personal exposure studies (35%). Overall, the most common method used for exposure-only EJ analyses was main effect regression modeling (50%); for epidemiologic studies the most common method was effect modification (58%), where an analysis evaluated a health disparity variable as an effect modifier. Summary Based on the results of this scoping review, current methods in public health EJ studies could be bolstered by integrating expertise from other fields (e.g., sociology), conducting community-based participatory research and intervention studies, and using more rigorous, theory-based, and solution-oriented statistical research methods.

Abstract Clean cooking transitions can have profound public health, environmental and societal gains for 2.6 billion people in the Global South. We use data from the largest household energy survey (n= 7,389) in Ghana to provide novel insights. One, regression analysis with thirteen commonly cited socio-economic and demographic predictors indicates that these factors have remarkably different levels of influence at different stages of the transition process. We propose a stage-based intervention strategy and customer targeting approach that could be a paradigm shift in how clean cooking interventions are rolled out. Two, we identify factors that are associated with exclusive use of LPG using a statistically powered sample of exclusive LPG users (n= 693). We find that everything else being equal, increases in wealth, and residing in an urban location are not associated with a transition from primary to exclusive LPG use.

Air pollution epidemiological studies usually rely on estimates of long-term exposure to air pollutants, which are difficult to ascertain. This problem is accentuated in settings where sources of personal exposure differ from those of ambient concentrations, including household air pollution environments where cooking is an important source. The objective of this study was to assess the feasibility of estimating usual exposure to PM2.5 based on short-term measurements. We leveraged three types of short-term measurements from a cohort of mother-child pairs in 26 communities in rural Ghana: (A) personal exposure to PM2.5 in mothers and age four children, ambient PM2.5 concentrations (B) at the community level, and (C) at a central site. Baseline models were linear mixed models with a random intercept for community or for participant. Lowest root-mean-square-error (RMSE) was used to select the best-performing model. We analyzed 240 community-days and 251 participant-days of PM2.5. Medians (IQR) of PM2.5 were 19.5 (36.5) μg/m3 for the central site, 28.7 (41.5) μg/m3 for the communities, 70.6 (56.9) μg/m3 for mothers, and 80.9 (74.1) μg/m3 for children. The ICCs (95% CI) for community ambient and personal exposure were 0.30 (0.17, 0.47) and 0.74 (0.65, 0.81) respectively. The sources of variability differed during the Harmattan season. Children’s daily exposure was best predicted by models that used community ambient compared to mother’s exposure as a predictor (log-scale RMSE: 0.165 vs 0.325). Our results support the feasibility of predicting usual personal exposure to PM2.5 using short-term measurements in settings where household air pollution is an important source of exposure. Our results also suggest that mother’s exposure may not be the best proxy for child’s exposure at age four.

Background: Natural gas-fueled stoves are a major source of indoor residential NO₂, which has been associated with asthma exacerbations. WE ACT for Environmental Justice launched 'Out of Gas' in 2021 to investigate the feasibility of transitioning from fossil fuels to renewable energy in affordable housing. 20 families in New York City Housing Authority units in the Bronx, New York City were selected to receive electric induction stoves to replace existing gas stoves. Air pollution (primarily NO₂ and PM2.5) and stove usage are being monitored before and after the transition. The pilot will be repeated in Buffalo, NY. Methods: In-kitchen stationary monitoring of NO₂, PM2.5, CO₂, and CO was conducted for 7 days at baseline and after stove switch-out using the Home Health Box (Access Sensor Technologies, Fort Collins, CO). Cooking events were identified using temperature loggers (Wellzion Electronics Technology Co, China). Pollutant concentrations were analyzed during cooking vs. non-cooking times and compared to ambient levels from nearby New York Department of Environmental Conservation stations. Results: Mean (SD) [median] NO₂ kitchen concentrations at baseline (before appliance switch-out) were 47.0 (60.6) [34.6] ppb, 27.8 ppb higher than ambient levels during the monitoring period. PM2.5 concentrations were 17.2 (40.1) [7.3] μg/m³, 7.9 μg/m³ higher than ambient levels. Levels of both pollutants were higher during cooking, with NO₂ averaging 117.5 (125.5) [82.3] ppb during cooking versus 35.5 (25.8) [32.5] ppb otherwise. The corresponding values for PM2.5 were 33.4 (63.7) [11.5] μg/m³ during cooking and 14.5 (33.8) [7.0] μg/m³ otherwise. On average, cooking was associated with an increase of 63.3 ppb NO₂ and 18.3 μg/m³ PM2.5 above baseline levels. Conclusions: Cooking with gas stoves contributes substantially to indoor residential NO₂ and PM2.5 concentrations. Switching to efficient electric induction stoves could reduce the exposure of potentially vulnerable populations to these pollutants. Keywords: NO₂, PM2.5, cookstoves

Background: Air pollution emissions have substantially decreased in the US since the 1970 Clean Air Act. We examined racial and economic disparities in emissions reductions from specific pollution sources. Methods: We evaluated racial/ethnic and economic disparities in emissions reductions from six pollution sectors [industry (SO2), energy (SO2), agriculture (NH3), commercial (NOx), residential (organic carbon), and on-road transport (NOx)] across the contiguous US from 1970–2010. We used the CEDGBD-MAP emissions inventory to estimate the average relative emissions change from one decennial to the following and its link to demographics (percent White, Black, Asian, American Indian Hispanic, family income, property value, poverty, and unemployment) at the county level. We constructed hierarchical models with the relative emissions change as the dependent variable and demographics as independent variables. We modeled each pollutant and demographic variable separately, adjusting for potential confounding, and tested for nonlinearities. Results: On average, national emissions decreased from 1970 to 2010 except in the agriculture and the residential sectors. The largest reductions across the study period were in industry and energy SO2 emissions (-66% and -89%, respectively) and on-road transport NOx (-59%). Although average emissions decreased nationally, trends varied across counties. We found racial disparities in industry, energy, and agriculture emissions. An increase in % American Indian, Hispanic, or Asian was associated with increases in industry SO2, agriculture NH3, and energy NOx. We also found economic disparities: an increase in median family income was associated with decreases in emissions from all sectors except agriculture, and increases in unemployment or poverty were associated with increases in industry and energy SO2 emissions. Conclusion: Although air pollution emissions, on average, decreased since 1970, the trends in emissions varied across counties. On average, low-income and communities of color have experienced smaller improvements or a relative increase in emissions despite the nationwide downward trends.

BACKGROUND AND AIM Burns and burn-related injuries are still a major public health problem. Every day, over 30,000 people suffer new severe burns worldwide. Low- and middle-income countries (LMICs) bear a disproportionate burden (70%) of these burns. While burn prevention strategies have successfully been implemented in high-income countries, a paucity of data regarding the incidence and risk factors of burns in LMICs limits their expansion. Here, we aimed to describe the country-level incidence of serious cooking-related burns in Ghana and to identify household-level risk factors for adults and children. METHODS We conducted a nationally representative household energy use survey in Ghana in 2020. The final sample included 7,389 households across 370 enumeration areas in all 16 regions of Ghana. An adapted version of the Global Alliance for Clean Cookstoves Burns Surveillance Module was administered to each respondent. We computed incidence rates and 95% confidence intervals using the Byar's approximation and conducted univariate logistic regression to identify potential risk factors. RESULTS Out of 7,389 households, we documented 129 serious cooking-related burns which had occurred in the previous 12 months. Slightly more than half (55%) of those burns occurred among adults. The incidence rate (95% CI) of cooking-related burns per 1000 person-years was 9.7 (7.7; 12) and 11 (8.5; 14) among adults and children respectively. Among adults, the odds (95% CI) of experiencing a serious cooking-related burn were 2.29 (1.02; 5.14) and 2.40 (1.04; 5.55) times higher among primary wood and charcoal users respectively compared to primary LPG users. No children burns were documented in households where LPG was primarily used. CONCLUSIONS Using a nationally representative sample, we characterized the incidence of cooking-related burns across demographic groups in Ghana. Solid fuel use compared to LPG use doubled the odds of experiencing such burns. KEYWORDS Burns; Solid fuel; Energy access; LMICs; Ghana