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.
Berkeley Air Monitoring Group, Berkeley, CA, USA.
Environ Int. 2023 Sep;179:108160. doi: 10.1016/j.envint.2023.108160. Epub 2023 Aug 19.
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.
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).
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.
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.
将家庭空气污染（HAP）降低到与健康益处相关的水平，需要几乎完全使用清洁烹饪燃料并放弃传统生物质燃料。
家庭空气污染干预网络（HAPIN）试验将危地马拉、印度、秘鲁和卢旺达的 3195 名孕妇随机分为接受液化石油气（LPG）炉干预组（n=1590）和对照组（n=1605），对照组预计将继续使用生物质燃料烹饪。我们通过燃料交付和维修记录、调查、观察和温度记录炉使用监测器（SUM）评估从怀孕开始到婴儿一岁生日期间干预实施的保真度和参与者对干预的依从性。
HAPIN 干预的保真度和依从性很高。重新灌装 LPG 钢瓶所需的中位数时间为 1 天（四分位距 0-2）。尽管 26%（n=410）的干预参与者报告在某个时候用完了 LPG，但这种情况发生的次数很少（中位数：1 天[Q1，Q3：1，2]），主要局限于 COVID-19 大流行的前四个月。大多数维修都是在报告问题的同一天完成的。仅在 3%的观察访问中观察到传统炉灶的使用，其中 89%的观察都进行了行为强化。根据 SUM 数据，干预家庭在所有监测日中，传统炉灶的使用中位数为 0.4%，81%的家庭每月使用传统炉灶<1 天。与 COVID-19 前（中位数[Q1，Q3]为 0.0%[0.0%，1.6%]的天数）相比，COVID-19 后（中位数[Q1，Q3]为 0.0%[0.0%，3.4%]的天数）传统炉灶的使用略高。出生前后干预的依从性没有显著差异。
免费炉灶和无限供应的 LPG 燃料送到参与家庭，加上及时的维修、行为信息传递和全面的炉灶使用监测，有助于 HAPIN 试验中干预的高度保真度和几乎完全使用 LPG。
