Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

Ashlinn K Quinn; Kendra N Williams; Lisa M Thompson; Steven A Harvey; Ricardo Piedrahita; Jiantong Wang; Casey Quinn; Ajay Pillarisetti; John P McCracken; Joshua P Rosenthal; Miles A Kirby; Anaité Diaz Artiga; Gurusamy Thangavel; Ghislaine Rosa; J Jaime Miranda; William Checkley; Jennifer L Peel; Thomas F Clasen

doi:10.3390/ijerph182312592

Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

Int J Environ Res Public Health. 2021 Nov 29;18(23):12592. doi: 10.3390/ijerph182312592.

Authors

Ashlinn K Quinn^{1

2}, Kendra N Williams^{3

4}, Lisa M Thompson⁵, Steven A Harvey⁶, Ricardo Piedrahita², Jiantong Wang⁷, Casey Quinn⁸, Ajay Pillarisetti⁷, John P McCracken^{9

10}, Joshua P Rosenthal¹, Miles A Kirby¹¹, Anaité Diaz Artiga¹⁰, Gurusamy Thangavel¹², Ghislaine Rosa¹³, J Jaime Miranda^{14

15}, William Checkley^{3

4

6}, Jennifer L Peel¹⁶, Thomas F Clasen⁷

Affiliations

¹ Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
² Berkeley Air Monitoring Group, Fort Collins, CO 80524, USA.
³ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
⁴ Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD 21287, USA.
⁵ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
⁷ Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
⁸ Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
⁹ Department of Epidemiology and Biostatistics, Global Health Institute, College of Public Health, University of Georgia, Athens, GA 30606, USA.
¹⁰ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala.
¹¹ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
¹² Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute for Higher Education and Research, Porur, Chennai 600116, India.
¹³ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
¹⁴ Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru.
¹⁵ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru.
¹⁶ Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA.

Abstract

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs).

Results: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0-15.0) days post-randomization and had a gestational age of 17.9 (15.4-20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days).

Conclusions: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

Keywords: LPG; adherence; cookstoves; fidelity; intervention; randomized controlled trial.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollution*
Air Pollution, Indoor* / analysis
Cooking
Female
Household Articles*
Humans
Infant
Petroleum*
Pregnancy
Rural Population

Substances

Petroleum

Abstract

Publication types

MeSH terms

Substances

Grants and funding