Project Abstract Household air pollution (HAP) from solid fuel combustion is a major contributor to poor ambient air pollution and health. Global efforts to address HAP in low- and middle-income countries have focused on provision of clean cookstoves. Household waste burning, especially of plastics, is a major, but unaddressed environmental and health hazard in countries that lack infrastructure to properly dispose of waste. In rural Guatemala, 95% of households use solid fuels for cooking and 71% burn waste as the primary means of disposal. Burning plastic releases bisphenols and phthalates, which may disrupt neurodevelopment, endocrine, and reproductive function. No studies have examined biomarkers of exposure to chemicals in women of reproductive age who are disproportionately exposed to airborne burning plastic, likely at higher levels than in high-income countries. There are no emissions estimates of air pollutants from plastic waste incineration in Central America. This proposal will implement community working groups that will improve air quality by reducing household plastic waste burning, reduce exposure, and improve health-related quality of life in women of reproductive age. Using a randomized cluster trial design, we will randomize 20 rural villages (10 intervention; 10 control) in Jalapa, Guatemala and randomly select 400 women of reproductive age (20 in each village) who report burning plastic trash as a primary form of waste disposal to participate in urine biomonitoring and personal air monitoring. In 10 intervention villages, we will invite community members to participate in 12-week working groups to implement alternatives to burning plastic and determine achievable interventions over the subsequent 9 months. We will use the Behavior Change Wheel and RE-AIM, two implementation science frameworks, and a mixed-methods approach, to refine, implement, and evaluate community-initiated interventions that address plastic waste. We will assess opportunities, capabilities and motivations that determine behaviors, as well as the reach, effectiveness, adoption, implementation fidelity, maintenance and sustainability of interventions. At baseline, 4 and 12 months, we will measure personal exposures to fine particulate matter and black carbon, and urinary biomarkers of exposure (e.g., bisphenols, phthalates, polycyclic aromatic hydrocarbons, and volatile organic compounds) in 400 women of reproductive age (15-44 years). We will use filter-based antimony and 1,3,5-Triphenylbenzene, known tracers of plastic incineration, to quantify emissions estimates of air pollutants due to plastic burning. Based on plastic waste reductions in intervention villages, we will assess regional impacts of pollutant emissions reduction, using a 3D chemical transport model. This is the first study to use an implementation science approach to implement and evaluate fidelity to intervention strategies to reduce plastic waste burning. Our findings will be incorporated into community-driven public health actions with policymakers to develop programs in other local contexts. This project has direct benefit not only to those residing in Guatemala, but also in other areas where open waste burning contributes to air pollutants both regionally and globally.

Project Narrative This cluster randomized trial is relevant to public health because it is the first implementation science study to develop and evaluate community-level working groups that aim to reduce household burning of plastic waste, a common exposure in rural low-income communities globally. Findings will be used to develop impactful community-driven public health actions in socially- and environmentally-disadvantaged communities in rural Guatemala. The project is relevant to the NIEHS mission because it fosters collaboration between research and community groups in the conduct of community-engaged research that aims to improve household and ambient air quality.