Effects of a liquefied petroleum gas stove intervention on pollutant exposure and adult cardiopulmonary outcomes (CHAP): study protocol for a randomized controlled trial

Magdalena Fandiño-Del-Rio, Dina Goodman, Josiah L Kephart, Catherine H Miele, Kendra N Williams, Mitra Moazzami, Elizabeth C Fung, Kirsten Koehler, Victor G Davila-Roman, Kathryn A Lee, Saachi Nangia, Steven A Harvey, Kyle Steenland, Gustavo F Gonzales, William Checkley, Cardiopulmonary outcomes and Household Air Pollution trial (CHAP) Trial Investigators, Magdalena Fandiño-Del-Rio, Dina Goodman, Josiah L Kephart, Catherine H Miele, Kendra N Williams, Mitra Moazzami, Elizabeth C Fung, Kirsten Koehler, Victor G Davila-Roman, Kathryn A Lee, Saachi Nangia, Steven A Harvey, Kyle Steenland, Gustavo F Gonzales, William Checkley, Cardiopulmonary outcomes and Household Air Pollution trial (CHAP) Trial Investigators

Abstract

Background: Biomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves.

Methods: We will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25-64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants.

Discussion: Findings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease.

Trial registration: ClinicalTrials.gov, ID: NCT02994680 , Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.

Keywords: Behavior change; Biomass fuel; Cardiopulmonary outcomes; Cookstove; Exclusive adoption; Household air pollution; Indoor air pollution; LPG; Personal exposure.

Conflict of interest statement

Ethics approval and consent to participate

The trial received approval by Johns Hopkins School of Public Health Institutional Review Board (IRB00007128), A.B. PRISMA Ethical Institutional Committee (CE2402.16), and Universidad Peruana Cayetano Heredia Institutional Review Board (SIDISI 66780). We will be requesting verbal consent to participate from all participants at the time of enrollment. Any amendments will undergo ethical review board approval at all institutions involved.

Consent for publication

Written informed consent was obtained from the participant for publication of their individual details and accompanying images in this manuscript. The Consent Form is held by the authors and is available for review by the Editor-in-Chief.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Expected study enrollment and timeline diagram
Fig. 2
Fig. 2
Location of all households in the study population and liquefied petroleum gas fuel purchase sites
Fig. 3
Fig. 3
Barplot of nearest-neighbor distances between households in study area. Median distance to nearest house between households in the study area is 101 m with an interquartile range of 56 to 189 m
Fig. 4
Fig. 4
Three-burner liquefied petroleum gas stove that will be used for the intervention
Fig. 5
Fig. 5
Delivery system through motorcycle for liquefied petroleum gas tanks
Fig. 6
Fig. 6
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Figure data collection schedule for the first year of follow-up
Fig. 7
Fig. 7
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Figure data collection schedule for the second year of follow-up
Fig. 8
Fig. 8
Portable particulate matter and carbon monoxide sampling devices
Fig. 9
Fig. 9
Placement of devices in an apron pocket to monitor personal exposure of particulate matter of less than 2.5 μm in aerodynamic diameter (PM2.5) and carbon monoxide (CO)

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Source: PubMed

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