Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

IntroductionIncreasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda.MethodsUsing the Capability, Opportunity, Motivation–Behaviour (COM–B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial.ResultsWe identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits.ConclusionOur formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.Trial registration numberNCT02944682, Pre-results.

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Household Air Pollution in Low and Middle Income Countries

Oxford Research Encyclopedia of Environmental Science ◽

10.1093/acrefore/9780199389414.013.25 ◽

2017 ◽

Author(s):

Caroline A. Ochieng ◽

Cathryn Tonne ◽

Sotiris Vardoulakis ◽

Jan Semenza

Keyword(s):

Air Pollution ◽

National Level ◽

Household Air Pollution ◽

Solid Fuels ◽

Chronic Obstructive ◽

Biomass Fuels ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Household air pollution from use of solid fuels (biomass fuels and coal) is a major problem in low and middle income countries, where 90% of the population relies on these fuels as the primary source of domestic energy. Use of solid fuels has multiple impacts, on individuals and households, and on the local and global environment. For individuals, the impact on health can be considerable, as household air pollution from solid fuel use has been associated with acute lower respiratory infections, chronic obstructive pulmonary disease, lung cancer, and other illnesses. Household-level impacts include the work, time, and high opportunity costs involved in biomass fuel collection and processing. Harvesting and burning biomass fuels affects local environments by contributing to deforestation and outdoor air pollution. At a global level, inefficient burning of solid fuels contributes to climate change. Improved biomass cookstoves have for a long time been considered the most feasible immediate intervention in resource-poor settings. Their ability to reduce exposure to household air pollution to levels that meet health standards is however questionable. In addition, adoption of improved cookstoves has been low, and there is limited evidence on how the barriers to adoption and use can be overcome. However, the issue of household air pollution in low and middle income countries has gained considerable attention in recent years, with a range of international initiatives in place to address it. These initiatives could enable a transition from biomass to cleaner fuels, but such a transition also requires an enabling policy environment, especially at the national level, and new modes of financing technology delivery. More research is also needed to guide policy and interventions, especially on exposure-response relationships with various health outcomes and on how to overcome poverty and other barriers to wide-scale transition from biomass fuels to cleaner forms of energy.

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Exposure contrasts of pregnant women during the Household Air Pollution Intervention Network randomized controlled trial

10.1101/2021.11.04.21265938 ◽

2021 ◽

Author(s):

Michael Johnson ◽

Ajay Pillarisetti ◽

Ricardo Piedrahita ◽

Kalpana Balakrishnan ◽

Jennifer L Peel ◽

...

Keyword(s):

Air Pollution ◽

Randomized Controlled Trial ◽

Pregnant Women ◽

Controlled Trial ◽

Household Air Pollution ◽

Liquefied Petroleum Gas ◽

Mixed Effect ◽

Randomized Controlled ◽

Life Years ◽

The Impact

Background: Exposure to PM2.5 arising from solid fuel combustion is estimated to result in approximately 2.3 million premature deaths and 90 million lost disability-adjusted life years annually. 'Clean' cooking interventions attempting to mitigate this burden have had limited success in reducing exposures to levels that may yield improved health outcomes. Objectives: This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial. Methods: The HAPIN trial included 3195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. 24-hour exposures to PM2.5, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (n=1605) and LPG arms (n=1590) and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels. Results: Median exposures of PM2.5, BC, and CO post-randomization in the intervention arm were lower by 66% (70.7 versus 24.0 µg/m3), 71% (9.6 versus 2.8 µg/m3), and 83% (1.2 versus 0.2 ppm), respectively, compared to the control arm. Exposure reductions were similar across research locations. Post-intervention PM2.5 exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of PM2.5 samples falling below the WHO Annual Interim Target 1 of 35 µg/m3. Discussion: This study indicates that an LPG intervention with high displacement of traditional cooking can reduce exposures to levels thought to be associated with health benefits. Success in reducing exposures was likely due to strong performance of, and high adherence to the intervention. Keywords (5-8): Liquefied petroleum gas, clean cooking, intervention, exposure assessment, PM2.5

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The Effects of Household Air Pollution (HAP) on Lung Function in Children: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211973 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11973

Author(s):

Sathya Swarup Aithal ◽

Shireen Gill ◽

Imran Satia ◽

Sudhir Kumar Tyagi ◽

Charlotte E. Bolton ◽

...

Keyword(s):

Systematic Review ◽

Air Pollution ◽

Growth Rate ◽

Lung Function ◽

Solid Fuel ◽

Household Air Pollution ◽

World Health ◽

Solid Fuels ◽

Inverse Association ◽

The Impact

The World Health Organization (WHO) estimates that around 3 billion people today are exposed to smoke from the household combustion of solid fuels. While the household use of solid fuels has decreased over the last few decades, it remains a leading modifiable risk factor for the global burden of disease. This systematic review analyzed the impact of Household Air Pollution (HAP) on lung function in children (under 18 years of age), as this is the time period of accelerated growth rate until full skeletal maturity. Data from 11 published studies demonstrated that exposure to smoke from solid fuel was associated with a lower growth rate of several lung function indices (FVC, FEV1, FEF25–75) in children. However, there was no observed association between HAP and the FEV1/FVC ratio over time. Although the evidence suggests an inverse association between high exposure to HAP and lung function indices, there is a lack of longitudinal data describing this association. Therefore, precaution is needed to reduce the smoke exposure from solid fuel burning.

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Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention

Environment International ◽

10.1016/j.envint.2017.11.018 ◽

2018 ◽

Vol 111 ◽

pp. 71-79 ◽

Cited By ~ 16

Author(s):

Kyle Steenland ◽

Ajay Pillarisetti ◽

Miles Kirby ◽

Jennifer Peel ◽

Maggie Clark ◽

...

Keyword(s):

Air Pollution ◽

Health Benefits ◽

Household Air Pollution ◽

Potential Health

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Distribution of sources of household air pollution: a cross-sectional study in Cameroon

10.21203/rs.3.rs-21688/v4 ◽

2021 ◽

Author(s):

Esong Miranda Baame ◽

André Pascal Goura ◽

Bertrand Hugo Ngahane Mbatchou ◽

Berenice Walage ◽

Herman Styve Yomi Simo ◽

...

Keyword(s):

Air Pollution ◽

Rural Communities ◽

Health District ◽

Household Air Pollution ◽

Easy Access ◽

Population Exposure ◽

Liquefied Petroleum Gas ◽

Cross Sectional Survey ◽

Related Factors ◽

Cross Sectional

Abstract Background: Household air pollution (HAP) is a recognised risk factor for many diseases, including respiratory diseases, cardiovascular/circulatory disorders, adverse pregnancy outcomes and cataracts. Population exposure to biomass fuels, including wood, varies among countries and from one fuel source to the other. This study aimed to investigate the different sources of HAP in peri-urban and rural communities in Cameroon. Methods: A cross-sectional survey was conducted in a representative sample of households from the Dschang Health District (DHD) region. This included 848 homes in which a range of fuels for cooking including biomass (firewood, charcoal, sawdust), kerosene and liquefied petroleum gas (LPG) were used both indoors and outdoors. Results: Of the study households, 651 (77%) reported exclusive use of firewood and 141 (17%) reported using more than one source of fuel. Exclusive use of firewood was greater in rural communities (94%) than in peri-urban communities (38%). In peri-urban communites, use of multiple fuels including LPG, wood, sawdust and kerosene, was more common (44.75%). A total of 25.03% of households in both peri-urban and rural communities reported using bottled gas (or liquified petroleum gas (LPG) for cooking. Motivations for choice of fuel included, price, availability (easy access), rapidity, tradition or culture related factorsConclusion: Wood is the main cooking fuel in both peri-urban and rural communities in the Dschang Health District. Work to help households (especially those who are resource poor) to adopt LPG equipment for cooking, and use in a more exclusive way is required.

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Abstract 17973: Biomass Fuel Use is Associated With Elevated Blood Pressure and Hypertension Status in Puno, Peru

Circulation ◽

10.1161/circ.130.suppl_2.17973 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Melissa S Burroughs Pena ◽

Karina Romero ◽

Antonio Bernabe Ortiz ◽

Eric J Velazquez ◽

J. Jaime Miranda ◽

...

Keyword(s):

Blood Pressure ◽

Air Pollution ◽

Systolic Blood Pressure ◽

Self Report ◽

Biomass Fuel ◽

Household Air Pollution ◽

Biomass Fuels ◽

Fuel Use ◽

The Impact ◽

The Relationship

Background: Household air pollution from biomass fuel use affects 3 billion people worldwide. There are few studies that examine the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with higher blood pressure and increased hypertension in Peru. Methods: We analyzed baseline information from an age- and sex-matched, population-based study in Puno, Peru. Daily biomass fuel use was self-reported. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mmHg; diastolic blood pressure (DBP) ≥90 mmHg; or self-report of diagnosis and anti-hypertensive medications. We used linear and logistic multivariable regressions, adjusting for age, sex, daily cigarette use and body mass index, to examine the relationship between daily biomass fuel use with blood pressure and hypertension, respectively. Results: Data from 1004 individuals (mean age 55.3 years, 51.7% female) were included. There was evidence of an association between daily biomass fuel use and hypertension (adjusted OR = 2.1, 95%CI 1.2 to 3.5). Subjects who reported daily use of biomass fuels had 6.0 mmHg (95% CI 4.1 to 8.0) higher SBP and 4.8 mmHg (95%CI 3.5 to 6.0) higher DBP compared to those who did not use biomass fuels daily. In a secondary analysis, we used rural residence (vs. urban) as a proxy of biomass daily use and the relationship with hypertension and systolic blood pressure was similar: a higher odds of hypertension (adjusted OR = 2.1, 95%CI 1.3 to 3.6), and higher SBP (6.7mmHg, 95% CI 4.8 to 8.6) and DBP (5.5 mmHg, 95% CI 4.3 to 6.8) in rural vs. urban participants. Conclusion: Biomass fuel use is associated with increased odds of hypertension and higher blood pressure in Puno, Peru. Reducing exposure to air pollution from biomass fuel use represents a potential opportunity for cardiovascular prevention in rural communities worldwide. Longitudinal studies to evaluate the impact of reducing household air pollution are needed.

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