Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial

Kendra N Williams; Ashlinn Quinn; Hayley North; Jiantong Wang; Ajay Pillarisetti; Lisa M Thompson; Anaité Díaz-Artiga; Kalpana Balakrishnan; Gurusamy Thangavel; Ghislaine Rosa; Florien Ndagijimana; Lindsay J Underhill; Miles A Kirby; Elisa Puzzolo; Shakir Hossen; Lance A Waller; Jennifer L Peel; Joshua P Rosenthal; Thomas F Clasen; Steven A Harvey; William Checkley; HAPIN Investigators

doi:10.1016/j.envint.2023.108160

Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial

Environ Int. 2023 Sep:179:108160. doi: 10.1016/j.envint.2023.108160. Epub 2023 Aug 19.

Authors

Kendra N Williams¹, Ashlinn Quinn², Hayley North³, Jiantong Wang⁴, Ajay Pillarisetti⁵, Lisa M Thompson⁶, Anaité Díaz-Artiga⁷, Kalpana Balakrishnan⁸, Gurusamy Thangavel⁸, Ghislaine Rosa⁹, Florien Ndagijimana¹⁰, Lindsay J Underhill¹¹, Miles A Kirby¹², Elisa Puzzolo⁹, Shakir Hossen¹, Lance A Waller⁴, Jennifer L Peel¹³, Joshua P Rosenthal³, Thomas F Clasen¹⁴, Steven A Harvey¹⁵, William Checkley¹⁶; HAPIN Investigators

Affiliations

¹ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
² Berkeley Air Monitoring Group, Berkeley, CA, USA.
³ Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
⁴ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, CA, USA.
⁶ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁸ ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
⁹ Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
¹⁰ Eagle Research Center Limited, Kigali, Rwanda.
¹¹ Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA.
¹² Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.
¹³ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁵ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁶ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. Electronic address: wcheckl1@jhmi.edu.

Abstract

Background: Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n = 1,590), with controls expected to continue cooking with biomass fuels (n = 1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs).

Results: Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0-2). Although 26% (n = 410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove < 1 day per month. Traditional stove use was slightly higher post-COVID-19 (detected on a median [Q1, Q3] of 0.0% [0.0%, 3.4%] of days) than pre-COVID-19 (0.0% [0.0%, 1.6%] of days). There was no significant difference in intervention adherence pre- and post-birth.

Conclusion: Free stoves and an unlimited supply of LPG fuel delivered to participating homes combined with timely repairs, behavioral messaging, and comprehensive stove use monitoring contributed to high intervention fidelity and near-exclusive LPG use within the HAPIN trial.

Trial registration: ClinicalTrials.gov NCT02944682.

Keywords: Adherence; Clean cooking; Health behavior change; Household air pollution; Intervention fidelity; Liquefied petroleum gas.

Publication types

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

MeSH terms

Air Pollution*
COVID-19*
Female
Humans
Infant
Pandemics
Petroleum*
Pregnancy
Research Design

Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial

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Abstract

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