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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

Author

Listed:
  • Ashlinn K. Quinn

    (Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
    Berkeley Air Monitoring Group, Fort Collins, CO 80524, USA)

  • Kendra N. Williams

    (Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
    Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD 21287, USA)

  • Lisa M. Thompson

    (Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA)

  • Steven A. Harvey

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Ricardo Piedrahita

    (Berkeley Air Monitoring Group, Fort Collins, CO 80524, USA)

  • Jiantong Wang

    (Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Casey Quinn

    (Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA)

  • Ajay Pillarisetti

    (Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • John P. McCracken

    (Department of Epidemiology and Biostatistics, Global Health Institute, College of Public Health, University of Georgia, Athens, GA 30606, USA
    Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala)

  • Joshua P. Rosenthal

    (Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA)

  • Miles A. Kirby

    (Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA)

  • Anaité Diaz Artiga

    (Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala)

  • Gurusamy Thangavel

    (Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute for Higher Education and Research, Porur, Chennai 600116, India)

  • Ghislaine Rosa

    (Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK)

  • J. Jaime Miranda

    (Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
    CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru)

  • William Checkley

    (Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
    Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD 21287, USA
    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Jennifer L. Peel

    (Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA)

  • Thomas F. Clasen

    (Rollins School of Public Health, Emory University, Atlanta, GA 30322, 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.

Suggested Citation

  • 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. , 2021. "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," IJERPH, MDPI, vol. 18(23), pages 1-18, November.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:23:p:12592-:d:691158
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    References listed on IDEAS

    as
    1. Rema Hanna & Esther Duflo & Michael Greenstone, 2016. "Up in Smoke: The Influence of Household Behavior on the Long-Run Impact of Improved Cooking Stoves," American Economic Journal: Economic Policy, American Economic Association, vol. 8(1), pages 80-114, February.
    2. Shankar, Anita V. & Quinn, Ashlinn K. & Dickinson, Katherine L. & Williams, Kendra N. & Masera, Omar & Charron, Dana & Jack, Darby & Hyman, Jasmine & Pillarisetti, Ajay & Bailis, Rob & Kumar, Praveen , 2020. "Everybody stacks: Lessons from household energy case studies to inform design principles for clean energy transitions," Energy Policy, Elsevier, vol. 141(C).
    3. Obianuju B. Ozoh & Tochi J. Okwor & Olorunfemi Adetona & Ayesha O. Akinkugbe & Casmir E. Amadi & Christopher Esezobor & Olufunke O. Adeyeye & Oluwafemi Ojo & Vivian N. Nwude & Kevin Mortimer, 2018. "Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG)," IJERPH, MDPI, vol. 15(4), pages 1-13, March.
    4. Dickinson, Katherine L. & Piedrahita, Ricardo & Coffey, Evan R. & Kanyomse, Ernest & Alirigia, Rex & Molnar, Timothy & Hagar, Yolanda & Hannigan, Michael P. & Oduro, Abraham Rexford & Wiedinmyer, Chri, 2019. "Adoption of improved biomass stoves and stove/fuel stacking in the REACCTING intervention study in Northern Ghana," Energy Policy, Elsevier, vol. 130(C), pages 361-374.
    5. Alison Pye & Sara Ronzi & Bertrand Hugo Mbatchou Ngahane & Elisa Puzzolo & Atongno Humphrey Ashu & Daniel Pope, 2020. "Drivers of the Adoption and Exclusive Use of Clean Fuel for Cooking in Sub-Saharan Africa: Learnings and Policy Considerations from Cameroon," IJERPH, MDPI, vol. 17(16), pages 1-24, August.
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    Cited by:

    1. Perros, T. & Allison, A.L. & Tomei, J. & Aketch, V. & Parikh, P., 2023. "Cleaning up the stack: Evaluating a clean cooking fuel stacking intervention in urban Kenya," Renewable and Sustainable Energy Reviews, Elsevier, vol. 188(C).
    2. William Checkley & Shakir Hossen & Ghislaine Rosa & Lisa M. Thompson & John P. McCracken & Anaite Diaz-Artiga & Kalpana Balakrishnan & Suzanne M. Simkovich & Lindsay J. Underhill & Laura Nicolaou & St, 2022. "Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial," IJERPH, MDPI, vol. 19(7), pages 1-12, March.

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