Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution

• Type of Material: Article
• Authors: Thomas Clasen, Emory University; William Checkley, Johns Hopkins University; Jennifer L. Peel, Colorado State University; Kalpana Balakrishnan, Sri Ramachandra Insitute; John P. McCracken, Universidad del Valle de Guatemala; Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Lisa Thompson, Emory University; Dana Barr, Emory University; Maggie L. Clark, Colorado State University; Michael A. Johnson, Berkeley Air Monitoring Group; Lance Waller, Emory University; Lindsay M. Jaacks, Harvard TH Chan School of Public Health; Nelson Steenland, Emory University; J. Jaime Miranda, Universidad Peruana Cayetano Heredia; Howard Chang, Emory University; Dong-Yun Kim, National Institutes of Health; Eric D. McCollum, Johns Hopkins University; Victor G. Davila-Roman, Washington University in St. Louis; Aris Papageorghiou, University of Oxford; Joshua P. Rosenthal, National Institutes of Health
• Language: English
• Date: 2020-04-01
• Publisher: US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2020, Public Health Services, US Dept of Health and Human Services. All rights reserved.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1289/EHP6407
• Title of Journal or Parent Work: ENVIRONMENTAL HEALTH PERSPECTIVES
• Volume: 128
• Issue: 4
• Start Page: 47008
• End Page: 47008
• Grant/Funding Information: The HAPIN trial is funded by the NIH (cooperative agreement 1UM1HL134590) in collaboration with the Bill & Melinda Gates Foundation (OPP1131279). Participating NIH organizations include the NHLBI; National Institute of Environmental Health Sciences (NIEHS); National Cancer Institute (NCI); National Institute of Child Health and Human Development (NICHD); Fogarty International Center (FIC); and the NIH Common Fund.
• Keywords: Environmental Sciences; COOKSTOVE INTERVENTION; CARBON-MONOXIDE; Life Sciences & Biomedicine; GLOBAL BURDEN; Toxicology; BLOOD-PRESSURE; BIRTH-WEIGHT; Environmental Sciences & Ecology; COMPARATIVE RISK-ASSESSMENT; Science & Technology; CHIMNEY STOVE; YOUNG-CHILDREN; FINE PARTICULATE MATTER; Public, Environmental & Occupational Health; HOUSEHOLD AIR-POLLUTION
• Research Categories: Engineering, Environmental; Health Sciences, Pathology; Health Sciences, Toxicology; Health Sciences, Public Health

Abstract

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low-and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2:5 lm (PM2:5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations.