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The policy\u2019s health impacts on respiratory outcomes have not been empirically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the impact of the CHP on respiratory symptoms and airway inflammation using a difference-in-differences design leveraging the policy\u2019s staggered rollout across rural Beijing villages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 1003 adults aged \u226540\u2009years from 50 rural villages reliant on coal heating at baseline (2018-2019). Over 4 winters (2018-2022), 20 villages were enrolled in the CHP. During up to 3 winter waves of data collection, we measured respiratory symptoms by questionnaire and, in a subsample, measured fractional exhaled nitric oxide (FeNO). We estimated the policy\u2019s effects using extended 2-way fixed effects models, accounting for village-level clustering and potential time-varying confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Exposure to the CHP was associated with a 7.5 percentage point reduction (95% confidence interval (CI): \u221212.8, \u22122.3) in the prevalence of any respiratory symptom, primarily driven by reductions in reported difficulty breathing (\u22123.3 pp, 95% CI: \u22128.0, 1.3), shortness of breath (\u22123.5 pp, 95% CI: \u22129.3, 2.3), and cough (\u22122.8 pp, 95% CI: \u22127.3, 1.6). We observed no evidence of an effect of the CHP on FeNO (0.3\u2009ppb, 95% CI: \u22122.2, 2.8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CHP led to reductions in reported respiratory symptoms among Beijing adults. This study contributes to the limited empirical evidence that clean energy policies can yield health benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag181","type":"journal-article","created":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T11:39:18Z","timestamp":1776598758000},"page":"2061-2070","source":"Crossref","is-referenced-by-count":6,"title":["Effects of China\u2019s Clean Heating Policy on respiratory symptoms and airway inflammation in adults: a quasi-experimental study in rural Beijing"],"prefix":"10.1093","volume":"212","author":[{"given":"Kaibing","family":"Xue","sequence":"first","affiliation":[{"name":"College of Resources and Environment, University of Chinese Academy of Sciences , Beijing,","place":["China"]},{"name":"Beijing Yanshan Earth Critical Zone National Research Station, University of Chinese Academy of Sciences , Beijing,","place":["China"]},{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill 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