Applied Implementation Research for Clean Cooking in Cambodia (AIR-C3)

Applied Implementation Research for Clean Cooking in Cambodia: Equity, Exposure, Costs, and Benefits of Induction Stove Interventions

The goal of this study is to learn how to help families in Cambodia switch to using electric induction stoves instead of traditional stoves that burn wood or charcoal. The study will also look at whether this switch is safe, affordable, and sustainable over time.

The main questions researchers want to answer are:

• What strategies work best to encourage families to use induction stoves regularly and stop using traditional cooking methods?
• Does switching to induction cooking reduce household air pollution for primary cooks?
• What are the costs and benefits of these strategies?

To answer these questions, researchers will compare different strategies across 65 peri-urban villages in Cambodia. They will use data loggers to track when families use induction stoves or traditional stoves, and measure air pollution levels in the home before and after families receive induction stoves.

Participants will:

• Receive an electric induction stove and support based on their group's strategy
• Have their stove use tracked through special devices
• Take part in air pollution measurements in their homes
• Share information about their cooking habits and experiences

Study Overview

• Status: Recruiting
• Conditions: Exposure to Environmental Pollution; Exposure to Household Air Pollution
• Intervention / Treatment: Other: Electric Induction Cookstoves

Detailed Description

Around 3 billion people worldwide cook using biomass fuels like wood, charcoal, and animal dung, which creates household air pollution responsible for about 2.3 million premature deaths each year from diseases such as heart disease, respiratory illnesses, diabetes, and cancer. Previous efforts to clean up biomass fuel burning have not sufficiently reduced air pollution or replaced traditional stoves, leading researchers to explore even cleaner alternatives like electric induction cooking.

This study evaluates whether electric induction stoves can effectively lower household air pollution in Cambodia. Using a rigorous, multi-year, cluster-randomized trial in 65 peri-urban villages, the study will:

• Develop and test different strategies (such as direct sales, subsidies, and community promotion) to encourage the purchase and regular use of induction stoves.
• Measure stove usage with cloud-connected data loggers that record cooking times and energy consumption.
• Collect household air pollution data and conduct surveys and interviews with approximately 3,100 households, with a focus on primary cooks.

The study also includes a comprehensive cost-effectiveness analysis to understand the benefits in terms of health, environmental impact, time savings, including impacts on individuals responsible for household cooking or fuel collection. By using established frameworks to plan, evaluate, and improve implementation (RE-AIM: Reach, Effectiveness, Adoption, Implementation, and Maintenance; CFIR: Consolidated Framework for Implementation Research), the research aims to build a strong evidence base to support the scale-up of clean cooking interventions in Cambodia and other low- and middle-income settings.

• Study Type: Interventional
• Enrollment (Estimated): 6150
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Matthew Freeman, PhD; Phone Number: 404-712-8767; Email: matthew.freeman@emory.edu
• Study Contact Backup: Name: Jedidiah Snyder; Email: jedidiah.snyder@emory.edu

Study Locations

• Cambodia
  • Kampong Speu Province
    • Kampong Speu, Kampong Speu Province, Cambodia
      • Recruiting
      • International Development Enterprises: iDE
      • Contact: Jennifer Roglà, PhD
      • Contact: SayPhearak Mak

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

- A household must:

• Provide consent to participate in our study, with at least one adult household member who identifies as the primary cook consenting to serve as the study participant
• Resides in village selected for implementation
• Household has electricity access
• Household does not already use electricity-based induction cooking technology

Exclusion Criteria:

-Plans to move permanently outside the study area in the next 12 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Community-based demand generation only; The implementation strategy consists of community-based demand generation and behavior change communication activities, including village meetings, cooking and stove demonstrations, and locally appropriate communication materials designed to build awareness, trust, and confidence in induction cooking	Other: Electric Induction Cookstoves; The intervention consists of high-quality, locally available electric induction cookstoves with two burners, each equipped with cloud-connected data loggers, and includes compatible cookware.
Experimental: Community-based demand generation + direct sales; The implementation strategy encompasses community-based demand generation and behavior change communication, complemented by personalized direct sales engagement. Trained sales agents conduct door-to-door and small-group visits, provide tailored sales pitches and demonstrations, respond to questions, and facilitate stove purchases.	Other: Electric Induction Cookstoves; The intervention consists of high-quality, locally available electric induction cookstoves with two burners, each equipped with cloud-connected data loggers, and includes compatible cookware.
Experimental: Community-based demand generation + subsidies; The implementation strategy includes community-based demand generation and behavior change communication, paired with financial support through stove subsidies. Subsidies include a lower-value subsidy available to early non-poor purchasers and a higher-value subsidy targeted to households classified as poor or at-risk.	Other: Electric Induction Cookstoves; The intervention consists of high-quality, locally available electric induction cookstoves with two burners, each equipped with cloud-connected data loggers, and includes compatible cookware.
Experimental: Community-based demand generation + direct sales + subsidies; The implementation strategy includes community-based demand generation and behavior change communication, personalized direct sales engagement, and financial support through stove subsidies. Sales agents provide household-level engagement and facilitate purchases, while subsidies improve affordability through both lower-value and targeted higher-value support.	Other: Electric Induction Cookstoves; The intervention consists of high-quality, locally available electric induction cookstoves with two burners, each equipped with cloud-connected data loggers, and includes compatible cookware.
No Intervention: Control villages; Control Villages assigned to the control arm will receive no study intervention during the trial period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Induction cookstove purchase: Proportion of households that purchase an induction stove	Purchase will be defined as the acquisition of an induction stove during the trial period, as reported in household surveys and verified through study-linked sales records matched to household study IDs. The outcome will be calculated as the number of participating households with a confirmed induction stove acquired divided by the total number of households in each village. Results will be reported overall and stratified by household poverty status, verified by the Cambodian Government (IDPoor status).	Endline, 18-30 months post-intervention
Disuse of biomass fuels: Proportion of meals cooked without biomass fuels	Disuse will be defined as the reduction in biomass fuel use for cooking, measured as the proportion of meals cooked without biomass fuels (e.g., firewood and charcoal) during a defined recent reference period, as reported in household surveys. Results will be reported overall and stratified by household poverty status.	Endline, 18-30 months post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Induction stove use: Daily electricity consumption of cooking events	Daily electricity consumption (kWh) associated with induction cookstove use, measured using built-in, cloud-connected data loggers that record energy use during cooking events among households that purchase an induction cookstove and consent to monitoring. Results will be summarized at the household and village level and stratified by household poverty status.	Up to 30 months following stove purchase
Induction cookstove use: Number of daily cooking events	Number of daily cooking events measured using built-in, cloud-connected data loggers installed on induction cookstoves. Cooking events will be derived from time-stamped stove activity among households that purchase an induction cookstove and consent to monitoring. Results will be summarized at the household and village level and stratified by household poverty status.	Up to 30 months following stove purchase
Induction cookstove use: Duration of daily cooking	Total duration of induction cookstove use per day, measured using built-in, cloud-connected data loggers based on time-stamped stove activity among households that purchase an induction cookstove and consent to monitoring. Results will be summarized at the household and village level and stratified by household poverty status.	Up to 30 months following stove purchase
Clean stove stacking patterns: Proportion of monitored days with no biomass stove use	Stove stacking will be defined as the concurrent use of multiple cooking technologies within a household, including biomass (e.g., firewood and charcoal), liquefied petroleum gas (LPG), and induction stoves. Stove use will be measured using thermocouple-based temperature loggers (Geocene Dots) installed on non-induction stoves. These devices record stove temperatures continuously and transmit data via Bluetooth to mobile devices, which sync to a central server. The outcome will be calculated as the proportion of monitored days with no biomass stove use and summarized at the household and village level, with results stratified by household poverty status.	Daily over a 1-week period, 6-8 weeks following stove purchase
Household air pollution: Personal exposure to fine particulate matter (PM2.5) and black carbon among primary cooks	Personal exposure to PM2.5 and black carbon will be measured among primary cooks using wearable personal exposure monitors (Ultrasonic Personal Aerosol Sampler) placed in the breathing zone of the primary cook for a continuous 24-hour period. Measurements will be collected among households that purchase an induction cookstove and a time-series matched subset of households that do not purchase. The outcome will be defined as 24-hour average PM2.5 (µg/m³) and black carbon concentrations and summarized at the household and village level, with results stratified by household poverty status.	24-hour measurement, 6-8 weeks following stove purchase
Maintenance (behavioral): Induction cookstove use trajectories	Induction cookstove use trajectories will be assessed as longitudinal patterns of use among households that purchase an induction cookstove (e.g., sustained, increasing, declining, or discontinued use), measured using built-in, cloud-connected stove data loggers, including frequency of use, duration of use, and electricity consumption. Results will be summarized across households and villages and stratified by household poverty status.	Up to 30 months following stove purchase
Maintenance (behavioral): Determinants of sustained use and clean cooking behaviors	Determinants of sustained use, declining use, or discontinuation of induction stove use, as well as adoption and continued use of clean cooking technologies (e.g., LPG) and reliance on biomass fuels (e.g., firewood and charcoal), will be assessed using after-sales service and warranty records and structured household surveys. Measures will include household- and system-level factors such as stove functionality, repairs, service interactions, user-reported experiences, and contextual factors influencing adoption and use among both purchasing and non-purchasing households.	Throughout implementation and summarized at endline, 18-30 months post-intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reach: Number and proportion of households reached by implementation strategies	Reach will be defined as the extent to which households are exposed to implementation strategies. This will be measured as the proportion and characteristics of participating households reporting exposure to at least one implementation strategy, complemented by the number of individuals reached in each village based on program records of participation or contact by activity type. Results will be summarized across households and villages and stratified by household poverty status	Throughout implementation and summarized at endline, 18-30 months post-intervention
Organizational adoption of implementation strategies	Organizational adoption will be defined as the uptake and delivery of assigned implementation strategies by implementing organizations and delivery actors, including initiation and extent of delivery across planned components. Data will be collected through a combination of program implementation records documenting organizational participation and strategy delivery, and key informant interviews with representatives from each organization. Qualitative and quantitative data will be analyzed together to generate a comprehensive view of organizational adoption.	Throughout implementation and summarized at endline, 18-30 months post-intervention
Implementation fidelity (including adaptations)	Implementation fidelity will be defined as the extent to which core components and intended sequencing of implementation strategies are delivered as planned, including systematic documentation of adaptations (type, timing, and rationale), distinguishing planned adaptations from reactive modifications. Data will be collected through a combination of structured implementer surveys, routine process evaluation tools, and key informant interviews with delivery actors. Qualitative and quantitative data will be analyzed together to generate a comprehensive view of implementation fidelity.	Throughout implementation and summarized at endline, 18-30 months post-intervention
Implementation dose (quantity and quality of delivery)	Implementation dose will be defined as the quantity and quality of delivery of implementation strategies, including frequency, number, and duration of contacts (dose quantity), as well as the scope of content delivered and level of engagement (dose quality). Data will be collected through a combination of structured implementer surveys, routine process evaluation tools, and key informant interviews with delivery actors. Qualitative and quantitative data will be analyzed together to generate a comprehensive view of the implementation dose.	Throughout implementation and summarized at endline, 18-30 months post-intervention
Acceptability of implementation strategies	Implementation acceptability will be defined as the perceived satisfaction, appropriateness, and feasibility of implementation strategies among implementers and participating households. Data will be collected through a combination of program records, key informant interviews with delivery actors, and structured household surveys. Qualitative and quantitative data will be analyzed together to generate a comprehensive view of implementation acceptability.	Throughout implementation and summarized at endline, 18-30 months post-intervention

Collaborators and Investigators

• Sponsor: Emory University
• Collaborators: National Institute of Environmental Health Sciences (NIEHS)
• Investigators: Principal Investigator: Matthew Freeman, PhD, Rollins School of Public Health

Study record dates

Study Major Dates

• Study Start (Actual): October 13, 2025
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): May 1, 2029

Study Registration Dates

• First Submitted: March 24, 2025
• First Submitted That Met QC Criteria: April 16, 2025
• First Posted (Actual): April 24, 2025

Study Record Updates

• Last Update Posted (Actual): April 3, 2026
• Last Update Submitted That Met QC Criteria: March 30, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Cooking methods; Induction stoves
• Other Study ID Numbers: STUDY00007929; 1R01ES035395-01A1 (U.S. NIH Grant/Contract); 2025P013174 (Other Identifier: Emory IRB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

All de-identified individual participant data collected during the trial. Data sharing will comply with ethical standards and privacy regulations, ensuring individual participant confidentiality is maintained.

All necessary metadata, tools, and statistical code needed to validate and replicate the findings will be publicly accessible. This includes documentation of the methods used, data collection procedures, and specific parameters for the analysis.

• IPD Sharing Time Frame: Data will be shared either at the time of publication or at the end of the performance period of the extramural award that produced it, whichever comes first.
• IPD Sharing Access Criteria: A review committee will evaluate applications. Successful applicants will be required to sign data use agreements outlining the terms and conditions of data access. Data will be made available through a publicly accessible repository, where approved users can access the data, metadata, and any associated documentation
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No