- ICH GCP
- US-Register für klinische Studien
- Klinische Studie NCT02944682
Luftverschmutzung und Gesundheit von Haushalten: Ein LPG-Interventionsversuch in mehreren Ländern (HAPIN)
Studienübersicht
Status
Bedingungen
Intervention / Behandlung
Detaillierte Beschreibung
Weltweit verlassen sich fast 3 Milliarden Menschen zum Kochen und Heizen auf feste Brennstoffe, die überwiegende Mehrheit in Ländern mit niedrigem und mittlerem Einkommen (LMICs). Die daraus resultierende Luftverschmutzung in Haushalten (HAP) ist der drittgrößte Risikofaktor für die globale Krankheitslast im Jahr 2010 und verursacht jährlich schätzungsweise 4,3 Millionen Todesfälle, hauptsächlich bei Frauen und Kleinkindern. Frühere Eingriffe haben zu saubereren Kochherden auf Biomassebasis geführt, konnten jedoch die Exposition nicht auf ein Niveau reduzieren, das zu bedeutenden gesundheitlichen Verbesserungen führt. Es gab keine groß angelegten Feldversuche mit Kochherden mit Flüssiggas (LPG), wahrscheinlich die sauberste skalierbare Intervention.
Ziel dieser Studie ist es, eine randomisierte kontrollierte Studie zur Verteilung von LPG-Kochern und -Brennstoffen in 3.200 Haushalten in vier LMICs (Indien, Guatemala, Peru und Ruanda) durchzuführen, um strenge Beweise für potenzielle gesundheitliche Vorteile über die gesamte Lebensdauer zu liefern. Jeder Interventionsort wird 800 schwangere Frauen (im Alter von 18 bis 34 Jahren, 9 bis <20 Schwangerschaftswochen) rekrutieren und die Hälfte ihrer Haushalte nach dem Zufallsprinzip zuweisen, um LPG-Kocher und eine 18-Monats-Versorgung mit LPG zu erhalten. Es wird erwartet, dass Kontrollhaushalte weiterhin hauptsächlich mit festen Biomassebrennstoffen kochen und eine Vergütung erhalten, die auf einem einheitlichen Satz von versuchsweiten Grundsätzen basiert, die auf der Grundlage formativer Forschung an jeden Standort angepasst werden. Die Mutter wird zusammen mit ihrem Kind begleitet, bis das Kind 1 Jahr alt ist. In Haushalten mit einer zweiten, nicht schwangeren älteren erwachsenen Frau (im Alter von 40 bis <80 Jahren) werden die Forscher sie ebenfalls einschreiben und während der 18-monatigen Nachbeobachtungszeit begleiten, um die kardiopulmonalen, metabolischen und Krebsergebnisse zu bewerten. Um den Interventionseinsatz zu optimieren, werden die Forscher Strategien zur Verhaltensänderung implementieren. Diese Studie wird die Verwendung von Kochherden bewerten, wiederholte persönliche Expositionsbewertungen gegenüber HAP (PM2,5, Ruß, Kohlenmonoxid) durchführen und getrocknete Blutflecken und Urinproben für die Biomarkeranalyse und die Aufbewahrung von Bioproben bei allen Teilnehmern zu mehreren Zeitpunkten sammeln. Die primären Ergebnisse sind ein niedriges Geburtsgewicht, das Auftreten schwerer Lungenentzündungen und Wachstumsverzögerungen des Kindes sowie der Blutdruck bei älteren erwachsenen Frauen. Zu den sekundären Outcomes gehören Frühgeburt und Entwicklung des Kindes, mütterlicher Blutdruck während der Schwangerschaft und Endothelfunktion, Atembeeinträchtigung, Atherosklerose, krebserregende Metaboliten und Lebensqualität der älteren erwachsenen Frau.
Diese Studie wird sich mit den folgenden spezifischen Zielen befassen: (1) unter Verwendung einer Intent-to-Treat-Analyse die Wirkung einer randomisierten LPG-Herd- und Brennstoffintervention auf die Gesundheit in vier verschiedenen LMIC-Populationen unter Verwendung eines gemeinsamen Protokolls bestimmen; (2) Bestimmung der Expositions-Wirkungs-Beziehungen für HAP und Gesundheitsergebnisse; und (3) die Beziehungen zwischen LPG-Intervention und sowohl gezielten als auch explorativen Biomarkern für Exposition/Gesundheitseffekte zu bestimmen.
Diese Studie wird Beweise, einschließlich Kosten und Umsetzungsstrategien, liefern, um nationale und globale Richtlinien zur Verbreitung von LPG-Kochern bei gefährdeten Bevölkerungsgruppen zu informieren. Letztendlich wird dies tiefere Diskussionen auf politischer Ebene erleichtern und Anforderungen für die Initiierung und Aufrechterhaltung von HAP-Interventionen weltweit identifizieren.
Studientyp
Einschreibung (Tatsächlich)
Phase
- Unzutreffend
Kontakte und Standorte
Studienorte
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Departamento de Guatemala
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Guatemala City, Departamento de Guatemala, Guatemala, 01015
- Universidad del Valle de Guatemala
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Tamil Nadu
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Chennai, Tamil Nadu, Indien, 600116
- Sri Ramachandra Institute of Higher Education and Research
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Puno, Peru
- Puno Global Non-Communicable Disease Research Site, School of Medicine, Johns Hopkins University
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Kigali, Ruanda
- Rwanda Research Site, London School of Hygiene and Tropical Medicine, University of Liverpool
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Teilnahmekriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Beschreibung
Einschlusskriterien für Schwangere:
- Bestätigte Schwangerschaft (hCG-positiver Blut- oder Urintest)
- Alter 18 bis <35 Jahre (über Selbstauskunft)
- Verwendet überwiegend Biomasseofen
- Wohnt im Studiengebiet
- 9 - <20 Schwangerschaftswoche, bestätigt durch Ultraschall
- Einlingsschwangerschaft (ein Fötus)
- Lebensfähiger Fötus mit normaler fetaler Herzfrequenz (120-180 Schläge pro Minute) zum Zeitpunkt der Ultraschalluntersuchung
- Anhaltende Schwangerschaft zum Zeitpunkt der Randomisierung durch Selbstauskunft bestätigt
- Stimmt der Teilnahme mit informierter Zustimmung zu
Ausschlusskriterien für Schwangere:
- Raucht derzeit Zigaretten oder andere Tabakprodukte
- Plant, in den nächsten 12 Monaten dauerhaft außerhalb des Studiengebiets umzuziehen
- Verwendet überwiegend LPG-Kocher oder wird voraussichtlich in naher Zukunft überwiegend LPG verwenden
Einschlusskriterien für ältere erwachsene Frauen im gleichen Haushalt:
- Alter 40 bis <80 Jahre (über Selbstauskunft)
Ausschlusskriterien für ältere erwachsene Frauen im selben Haushalt:
- Raucht derzeit Zigaretten oder andere Tabakprodukte
- Schwanger (nach Selbstauskunft)
- Plant, in den nächsten 12 Monaten aus ihrem derzeitigen Haushalt auszuziehen
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Verhütung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Waffen und Interventionen
Teilnehmergruppe / Arm |
Intervention / Behandlung |
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Experimental: Kochherd mit Flüssiggas
Teilnehmer, die randomisiert dem experimentellen Arm zugeteilt werden, erhalten einen Kochherd mit Flüssiggas (LPG) und eine 18-Monats-Versorgung mit LPG.
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The intervention consists of a high-quality locally available liquefied petroleum gas (LPG) stove having at least two burners, a continuous supply of LPG fuel for 18 months, and the promotion of stove use on an exclusive basis for cooking.
The intervention will be provided free of charge to all intervention households upon enrollment.
On a weekly basis, study staff will examine stove condition, perform any necessary repairs, and measure and record weight of LPG tanks in order to anticipate need for refills.
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Kein Eingriff: Kontrolle
Die Teilnehmer der Kontrollgruppe erhalten keinen Flüssiggaskocher (LPG) und verwenden weiterhin traditionelle Kochmethoden (offenes Feuer oder traditionelle Öfen) oder die Kochmethode ihrer Wahl.
Kontrollhaushalte erhalten eine Vergütung basierend auf einem einheitlichen Satz von studienweiten Grundsätzen, die auf der Grundlage formativer Forschung an jeden Standort angepasst werden.
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Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Birth weight
Zeitfenster: Within 24 hours of birth (up to 5 months post-randomization of mother)
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Birth weight is assessed by a trained nurse or health worker within 24 hours of birth.
Infants are weighed naked or in a pre-weighed blanket.
Weight is measured to the nearest 10 g using a digital electronic scale, if performed by the study field staff; otherwise, hospital medical records are used.
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Within 24 hours of birth (up to 5 months post-randomization of mother)
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Incidence of HAPIN Defined Severe Pneumonia
Zeitfenster: Up to 12 months after birth
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The number of times a child has severe pneumonia over their period of follow-up during the first year of life is assessed.
For this study pneumonia criteria are adapted from the WHO classification of childhood pneumonia (2014) and there are 3 algorithms for case criteria: 1) the presence of cough and/or difficult breathing and at least 1 general danger sign plus evidence of pneumonia on lung imaging (i.e., lung ultrasound or chest x-ray), or 2) the presence of cough and/or difficult breathing and hypoxemia (measured either via pulse oximetry (SpO2), or observing a child requiring advanced respiratory support (i.e., intubation and mechanical ventilation, non-invasive ventilation with continuous or bi-level positive airway pressure support, or high-flow nasal cannula oxygen), or 3) children who die prior to evaluation but their death is attributed to pneumonia by verbal autopsy.
Cases of pneumonia are recorded children present to HAPIN health facilities with respiratory symptoms.
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Up to 12 months after birth
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Length-for-age z-score 2 standard deviations below the standard
Zeitfenster: 12 months after birth
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The primary outcome measured is stunting at one year of age, defined as a length-for-age z-score (LAZ) that is 2 standard deviations below the median of the growth standard.
Infant length is assessed at birth and quarterly thereafter, until the child is 12 months old.
Z-scores are calculated using the 2006 World Health Organization (WHO) Multi-Growth Reference Standard (MGRS).
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12 months after birth
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Systolic Blood Pressure Among Older Adult Women
Zeitfenster: Baseline, 3, 6, 9, 12, and 18 months post-randomization
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Systolic blood pressure is assessed in the older adult women in the intervention and control arms using automatic sphygmomanometers (Omron HEM-907XL; Osaka, Japan).
The study team uses the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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Baseline, 3, 6, 9, 12, and 18 months post-randomization
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Child Linear Growth During Extended Follow-up
Zeitfenster: 24, 36, 48 and 60 months of age
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Linear growth of children is assessed in centimeters of height.
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24, 36, 48 and 60 months of age
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Caregiver Reported Early Childhood Development Instrument (CREDI) Score During Extended Follow-up
Zeitfenster: 24 months of age
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Child development is assessed with the Caregiver Reported Early Childhood Development Instrument (CREDI).
The CREDI is a population-level measure of early childhood development (ECD) for children from 0-3 years of age.
The CREDI assesses 4 domains of child development: 1) motor (fine and gross motor), 2) language (expressive and receptive language), 3) cognitive (executive function, problem solving and reasoning, and pre-academic knowledge), and 4) social-emotional (emotional and behavioral self-regulation, emotional knowledge, and social competence).
The CREDI long form consists of up to 108 items and the number of questions answered depends on the age of the child.
Responses of "yes" are coded as 1 and "no" is coded as 0; certain items are reverse coded.
Both domain-specific and overall z-scores are calculated.
Total raw scores increase by age (with developmental progression), and higher scores indicate increased development.
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24 months of age
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Malawi Developmental Assessment Tool (MDAT) Score
Zeitfenster: 36, 48 and 60 months of age
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The MDAT measures gross motor (39 items), fine motor (42 items), language/cognition (40 items) and social skills (36 items).
Originally developed and validated in rural Malawi, it has now been used in over 25 countries with more than 8,000 children as both a clinical and research tool.
The MDAT is a continuous test with start and stop rules.
Most items are administered directly to the child and items that are not easily observed (e.g., child speaks in full sentences; child understands sharing with others; child can dress self) are administered by parent report.
Children receive either a pass or fail for each item, and summed pass scores can produce a composite score as well as domain-specific scores.
Total scores range from 0 to 157 where higher scores indicate greater neurodevelopment.
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36, 48 and 60 months of age
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Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Frühgeburt
Zeitfenster: Bis zu 5 Monate (innerhalb von 24 Stunden nach der Geburt, 3-5 Monate nach Randomisierung)
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Frühgeburt ist definiert als Geburt eines lebenden Säuglings vor Vollendung der 37. Schwangerschaftswoche.
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Bis zu 5 Monate (innerhalb von 24 Stunden nach der Geburt, 3-5 Monate nach Randomisierung)
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Krankenhausaufenthalt wegen Atemwegserkrankungen
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz von Krankenhauseinweisungen wegen einer Atemwegserkrankung im ersten Lebensjahr.
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Bis 12 Monate nach der Geburt
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WHO Nicht schwere Pneumonie
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz der nicht schweren Pneumonie der WHO (Definition 2014 und 2013) im ersten Lebensjahr.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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Schwere Pneumonie der WHO
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz der nicht schweren Pneumonie der WHO (Definition 2014 und 2013) im ersten Lebensjahr.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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WHO-Taschenbuch Nicht schwere Pneumonie
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz der nicht schweren Lungenentzündung der WHO im ersten Lebensjahr, wie in der zweiten Ausgabe des „Pocket book of hospital care for children“ (2013) definiert.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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WHO-Taschenbuch Schwere Lungenentzündung
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz der schweren Lungenentzündung der WHO im ersten Lebensjahr, wie in der zweiten Ausgabe des „Pocket book of hospital care for children“ (2013) definiert.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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Hypoxämische Pneumonie
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz hypoxämischer Pneumonie im ersten Lebensjahr.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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Ultraschall- oder Röntgenpneumonie
Zeitfenster: Bis 12 Monate nach der Geburt
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Kumulative Inzidenz von Lungenultraschall- oder Röntgenthorax-Pneumonie während des ersten Lebensjahres.
Fälle von Lungenentzündung werden erfasst, wenn Kinder mit Atemwegssymptomen in HAPIN-Gesundheitseinrichtungen vorstellig werden.
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Bis 12 Monate nach der Geburt
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Gestational Systolic Blood Pressure
Zeitfenster: Baseline (9-20 weeks gestation), 24-28 and 32-36 weeks gestation
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Blood pressure is assessed in the pregnant women in the intervention and control arms using automatic sphygmomanometers (OMRON HEM-907XL; Osaka, Japan).
The study team will use the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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Baseline (9-20 weeks gestation), 24-28 and 32-36 weeks gestation
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Gestational Diastolic Blood Pressure
Zeitfenster: Baseline (9-20 weeks gestation), 24-28 and 32-36 weeks gestation
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Blood pressure is assessed in the pregnant women in the intervention and control arms using automatic sphygmomanometers (OMRON HEM-907XL; Osaka, Japan).
The study team will use the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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Baseline (9-20 weeks gestation), 24-28 and 32-36 weeks gestation
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Systolic Blood Pressure in New Mothers
Zeitfenster: 9, 12, and 18 months post-randomization
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Blood pressure is assessed in the new mothers in the intervention and control arms using automatic sphygmomanometers (OMRON HEM-907XL; Osaka, Japan).
The study team will use the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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9, 12, and 18 months post-randomization
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Diastolic Blood Pressure in New Mothers
Zeitfenster: 9, 12, and 18 months post-randomization
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Blood pressure is assessed in the new mothers in the intervention and control arms using automatic sphygmomanometers (OMRON HEM-907XL; Osaka, Japan).
The study team will use the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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9, 12, and 18 months post-randomization
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Diastolic Blood Pressure Among Older Adult Women
Zeitfenster: Baseline, 3, 6, 12 and 18 months post-randomization
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Diastolic blood pressure is assessed in the older adult women in the intervention and control arms using automatic sphygmomanometers (Omron HEM-907XL; Osaka, Japan).
The study team uses the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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Baseline, 3, 6, 12 and 18 months post-randomization
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Mean arterial pressure
Zeitfenster: Baseline, 3, 6, 12 and 18 months post-randomization
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Mean arterial pressure is assessed in the older adult women in the intervention and control arms using automatic sphygmomanometers (Omron HEM-907XL; Osaka, Japan).
Mean arterial pressure is calculated as DBP+(SBP-DBP)/3, where SBP=systolic blood pressure and DBP=diastolic blood pressure.
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Baseline, 3, 6, 12 and 18 months post-randomization
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Pulse pressure
Zeitfenster: Baseline, 3, 6, 12 and 18 months post-randomization
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Pulse pressure is assessed in the older adult women in the intervention and control arms using automatic sphygmomanometers (Omron HEM-907XL; Osaka, Japan).
pressure.
Pulse pressure is the difference between systolic blood pressure and diastolic blood pressure.
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Baseline, 3, 6, 12 and 18 months post-randomization
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Fetal Growth
Zeitfenster: Baseline, Gestation Week 24-28 and Gestation Week 32-36
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Pregnant women have ultrasounds at Baseline and during gestation weeks 24-28 and gestation weeks 32-36 to measure fetal growth outcomes.
Specifically, the researchers evaluate head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) during gestation.
The researchers are comparing (i) z-scores of individual fetal growth measurements (HC, AC, FL, EFW) at the 2 growth ultrasound visits between intervention and control participants (separately at 24-28 weeks gestation and 32-36 weeks gestation); (ii) differences in proportions of the 2.5th percentiles of each of these measurements evaluated separately at 24-28 and 32-36 weeks gestation; (iii) Z-score trajectories of HC, AC, FL and EFW as a function of gestational age and intervention; and (iv) prevalence of small for gestational age (SGA) during the fetal period through birth as measured by WHO INTERGROWTH 21st standards.
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Baseline, Gestation Week 24-28 and Gestation Week 32-36
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Gestational age at birth
Zeitfenster: Up to 5 months (within 24 hours of birth, 3-5 months post randomization)
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Gestational age at birth is measured in weeks, as continuous outcome, among all live births.
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Up to 5 months (within 24 hours of birth, 3-5 months post randomization)
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Brachial artery reactivity testing (BART)
Zeitfenster: Baseline, 18 months post-randomization
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Brachial artery reactivity testing (BART) measures endothelial function via flow-mediated dilatation to reactive hyperemia following the release of arm blood-flow occlusion.
In this test, baseline artery diameter is measured, then a blood pressure cuff is inflated to induce distal arm ischemia for 5 minutes and after releasing the pressure, the post-occlusion brachial artery diameter is measured.
The ratio of post- to pre-occlusion artery diameter represents endothelial function where lower values indicate worse endothelial function.
(Peru only)
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Baseline, 18 months post-randomization
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Carotid intima-media thickness (CIMT) Among Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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The carotid intima-media thickness test (CIMT) is used to determine the extent of carotid atherosclerotic vascular disease.
The test measures the thickness of the inner two layers of the carotid artery and can detect plaque build up prior to physical symptoms being experienced.
The carotid ultrasound will be performed with a portable ultrasound by trained sonographers.
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Baseline, 18 months post-randomization
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St. George Respiratory Questionnaire (SGRQ) Score
Zeitfenster: Baseline, 18 months post-randomization
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Adult respiratory health and well-being is assessed with the St. George Respiratory Questionnaire (SGRQ).
The SGRQ measures impaired health and perceived well-being among individuals with chronic airway disease.
The SGRQ has sections assessing symptoms, activities that cause breathlessness or are limited because of breathlessness, and the impacts of respiratory problems on employment, sense of control of health, panic, stigmatization, medication use, side effects of therapies, expectations for health and disturbances of daily life.
The questionnaire includes multiple choice, true/false and open-ended questions.
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Baseline, 18 months post-randomization
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Short Form 36 Survey (SF-36) Score Among Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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The Short Form 36 survey (SF-36) is a standardized, preference-based 36 item questionnaire evaluating quality of life.
The survey has 8 sections (vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health).
Possible scores range from 0 (lowest quality of life) to 100 (highest quality of life).
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Baseline, 18 months post-randomization
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Weight
Zeitfenster: 24, 36, 48 and 60 months of age of the child
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Weight is measured in kilograms (kg).
Weight in new mothers in Rwanda is measured when the child is 24 months old.
For new mothers in Guatemala weight is measured when the child is 24 and 36 months old.
In older adult women, weight is measured when the child is 24 months old.
Weight is measured in children at 24, 36, 48 and 60 months of age.
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24, 36, 48 and 60 months of age of the child
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Body Mass Index (BMI)
Zeitfenster: 24, 36, 48 and 60 months of age of the child
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BMI is calculated as weight in kilograms divided by height in meters (m) squared (kg/m^2).
BMI in new mothers in Rwanda is calculated from height and weight measurements obtained when the child is 24 months old.
For new mothers in Guatemala BMI is calculated from height and weight measurements obtained when the child is 24 and 36 months old.
In older adult women, BMI is calculated from height and weight measurements obtained when the child is 24 months old.
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24, 36, 48 and 60 months of age of the child
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Height
Zeitfenster: 24 and 36 months of age of the child
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Height is measured in meters.
Height in new mothers in Rwanda is measured when the child is 24 months old.
For new mothers in Guatemala height is measured when the child is 24 and 36 months old.
In older adult women, height is measured when the child is 24-months old.
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24 and 36 months of age of the child
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Child Blood Pressure
Zeitfenster: 24 (Rwanda only) and 60 months of age
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Blood pressure is assessed in the children using automatic sphygmomanometers (OMRON HEM-907XL; Osaka, Japan).
The study team uses the procedures adapted from previously validated methods and cardiovascular outcome studies, following recommendations for the American Heart Association and the European Society of Hypertension.
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24 (Rwanda only) and 60 months of age
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Child Linear Growth
Zeitfenster: Birth (3-5 months post-randomization), and 3, 6, 9, and 12 months of age
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Linear growth of children is assessed in centimeters at birth and quarterly thereafter, until the child is 12 months old.
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Birth (3-5 months post-randomization), and 3, 6, 9, and 12 months of age
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Caregiver Reported Early Childhood Development Instrument (CREDI) Score
Zeitfenster: 3 and 12 months of age
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Child development is assessed with the Caregiver Reported Early Childhood Development Instrument (CREDI).
The CREDI is a population-level measure of early childhood development (ECD) for children from 0-3 years of age.
The CREDI assesses 4 domains of child development: 1) motor (fine and gross motor), 2) language (expressive and receptive language), 3) cognitive (executive function, problem solving and reasoning, and pre-academic knowledge), and 4) social-emotional (emotional and behavioral self-regulation, emotional knowledge, and social competence).
The CREDI long form consists of up to 108 items and the number of questions answered depends on the age of the child.
Responses of "yes" are coded as 1 and "no" is coded as 0; certain items are reverse coded.
Both domain-specific and overall z-scores are calculated.
Total raw scores increase by age (with developmental progression), and higher scores indicate increased development.
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3 and 12 months of age
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Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Spontane Abtreibung
Zeitfenster: Baseline bis zur 20. Schwangerschaftswoche
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Fetaler Tod vor 19 Wochen 6 Tage.
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Baseline bis zur 20. Schwangerschaftswoche
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Frühe Frühgeburt
Zeitfenster: Geburt
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Geburten mit einer abgeschlossenen Schwangerschaft von weniger als 34 Wochen unter allen Lebendgeburten.
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Geburt
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Totgeburt
Zeitfenster: Bis zur Geburt
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Alle fetalen Todesfälle, die während oder nach der 20. Schwangerschaftswoche auftraten ODER auf dem Formular für schwerwiegende unerwünschte Ereignisse ODER auf dem Formular für die Anamnese einer schwangeren Frau ODER auf dem Formular für die mündliche Autopsie angegeben sind.
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Bis zur Geburt
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Neugeborener Tod
Zeitfenster: Geburt bis 28 Tage
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Tod zwischen Geburt und 28 Tagen.
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Geburt bis 28 Tage
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Lungenfunktion bei Kindern
Zeitfenster: 36, 48 und 60 Monate alt
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Lungenfunktionsmessungen werden mithilfe der Forced-Oscillation-Technik (FOT) mit dem Tremoflo C-100-Gerät mit Einwegmundstücken durchgeführt.
FOT ist eine Technik, mit der Veränderungen der Atemwege frühzeitig erkannt werden können.
Das FOT-Gerät misst die Beziehung zwischen von außen angelegten Druckwellen und dem resultierenden Luftstrom, um die Atemimpedanz zu messen.
Bei hohen Frequenzen erzeugte Werte entsprechen den proximalen und großen Atemwegen, und bei niedrigen Frequenzen erzeugte Werte entsprechen den distalen und kleinen Atemwegen.
Diese Messung wird bei Kindern in Guatemala durchgeführt.
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36, 48 und 60 Monate alt
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Veränderung der Urin-Biomarker
Zeitfenster: Ausgangswert, 3, 6, 9, 12 und 18 Monate nach der Randomisierung und 24 Monate Alter des Kindes
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Es werden Biomarker für Mehrfachexpositionen gemessen: 3-OH-Cotinin, 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), Levoglucosan, 8OH-Desoxyguanosin (8OHdG) und Metaboliten flüchtiger organischer Chemikalien (VOC). .
Expositionsbiomarker (insbesondere für Kinder, deren Urin möglicherweise begrenzt ist) werden wie folgt priorisiert: Biomarker für polyzyklische aromatische Kohlenwasserstoffe (PAK), Levoglucosan, Biomarker für flüchtige organische Chemikalien (VOC), Schwermetalle und tabakbezogene Biomarker.
Urinbiomarker werden bei schwangeren Frauen zu Studienbeginn, in der 24.–28. Schwangerschaftswoche und in der 32.–36. Schwangerschaftswoche sowie bei jungen Müttern gemessen, wenn das Kind 24 Monate alt ist.
Biomarker werden bei älteren erwachsenen Frauen zu Studienbeginn, 3, 6, 9, 12 und 18 Monate nach der Randomisierung gemessen.
Biomarker werden bei Kindern im Alter von 3, 6, 12 und 24 Monaten gemessen.
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Ausgangswert, 3, 6, 9, 12 und 18 Monate nach der Randomisierung und 24 Monate Alter des Kindes
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Veränderung der DBS-Biomarker (Dried Blood Spot).
Zeitfenster: Ausgangswert, 3, 6, 9, 12 und 18 Monate nach der Randomisierung und im Alter von 24 Monaten des Kindes
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Die wichtigsten aus den getrockneten Blutflecken zu messenden Biomarker sind: Entzündungsmarker, endotheliale Marker für Herz-Kreislauf-Erkrankungen, Marker für oxidativen Stress, Hb, HbA1C, Tumor-assoziierte Antigen-Antikörper, Cytochrom P450, p53-Tumor-assoziiertes Antigen (TAA), Lipide, Metabolomik, MiRNA, Schwermetalle.
DBS-Biomarker werden bei schwangeren Frauen zu Studienbeginn, in der 24.–28. Schwangerschaftswoche und in der 32.–36. Schwangerschaftswoche sowie bei jungen Müttern gemessen, wenn das Kind 24 Monate alt ist.
DBS-Biomarker werden bei älteren erwachsenen Frauen zu Studienbeginn, 3, 6, 9, 12 und 18 Monate nach der Randomisierung gemessen.
DBS-Biomarker werden bei Kindern im Alter von 3, 6, 12 und 24 Monaten gemessen.
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Ausgangswert, 3, 6, 9, 12 und 18 Monate nach der Randomisierung und im Alter von 24 Monaten des Kindes
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Maternal Perceived Stress Scale (PSS)
Zeitfenster: 9 bis 18 Monate nach der Randomisierung (3 bis 12 Monate alt des Kindes)
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Die 10-Punkte-Skala für wahrgenommenen Stress (PPS) von Cohen bewertet die Art und Weise, wie eine Person ihre Lebensereignisse als stressig einschätzt (z. B. „Wie oft hatten Sie im letzten Monat das Gefühl, dass sich die Schwierigkeiten so stark anhäuften, dass Sie sie nicht überwinden konnten?“ ) (Cohen, 1983).
Die Antworten auf Likert-Ebene reichten von 0 (nie) bis 4 (sehr oft), was bedeutet, dass ein hoher PPS-Wert zu einem hohen Grad an wahrgenommenem Stress führen würde.
Ein PPS in spanischer Sprache wurde erstellt, getestet und für gültig und zuverlässig befunden (Vallijo et al., 2018).
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9 bis 18 Monate nach der Randomisierung (3 bis 12 Monate alt des Kindes)
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Frühgeburt
Zeitfenster: Geburt
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Einschließlich Früh- und Totgeburten.
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Geburt
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Ernährungsunsicherheit der Haushalte
Zeitfenster: Ausgangswert, 18 Monate nach der Randomisierung
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Die Ernährungsunsicherheit der Haushalte wird anhand der Food Insecurity Experience Scale (FIES) gemessen, die von der Ernährungs- und Landwirtschaftsorganisation (FAO) entwickelt und validiert wurde.
Das FIES-Modul umfasst acht Fragen mit jeweils Ja/Nein-Antwortmöglichkeiten zum Zugang des Haushalts zu angemessenen Nahrungsmitteln und soll drei Bereiche der Ernährungsunsicherheit messen: Unsicherheit/Angst, Nahrungsmittelmenge und Nahrungsmittelqualität.
Jede Frage nimmt Werte von 0/1 an, die zu einer möglichen Gesamtpunktzahl von 0-8 summiert werden.
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Ausgangswert, 18 Monate nach der Randomisierung
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Ernährungsvielfalt – Frauen
Zeitfenster: Ausgangswert bis 18 Monate nach der Randomisierung
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Die Ernährungsvielfalt von Frauen wird anhand des Fragebogens „Minimum Dietary Diversity – Women“ (MDD-W) der FAO und des FHI 360 gemessen, der ein offenes Recall-Format verwendet, um Daten zu den von der Befragten am Vortag und in der Nacht konsumierten Nahrungsmitteln und Getränken zu sammeln .
Die Antworten werden in zehn Lebensmittelgruppen kategorisiert, und Frauen, die angeben, fünf oder mehr der zehn Lebensmittelgruppen zu konsumieren, werden als Personen mit minimaler Ernährungsvielfalt eingestuft.
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Ausgangswert bis 18 Monate nach der Randomisierung
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Hämoglobin (Hb)-Konzentration / Anämie – Frauen
Zeitfenster: Baseline, 3 und 5 Monate nach der Randomisierung
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Hb wird aus einem einzelnen Tropfen Kapillarblut gemessen, der per Fingerstich mit dem Point-of-Care-Gerät HemoCue® Hb 201system (HemoCue® AB) gewonnen wird
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Baseline, 3 und 5 Monate nach der Randomisierung
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Hämoglobin (Hb)-Konzentration / Anämie – Säuglinge
Zeitfenster: 12 und 18 Monate nach der Randomisierung (6 und 12 Monate alt)
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Hb wird aus einem einzelnen Tropfen Kapillarblut gemessen, der per Fingerstich mit dem Point-of-Care-Gerät HemoCue® Hb 201system (HemoCue® AB) gewonnen wird
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12 und 18 Monate nach der Randomisierung (6 und 12 Monate alt)
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Change in fine particulate matter (PM2.5) exposure
Zeitfenster: Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Personal monitoring equipment is used to assess exposure to fine particulate matter (PM2.5) over a 24-hour period in intervention and control participants (pregnant women, older adult women, and children).
Exposure for pregnant women is measured at baseline, 24-28 weeks gestation, 32-36 weeks gestation, and in Guatemala and India, when the child is 24 months old.
Exposure for the child is measured at 3, 6, 12, 24, 36, 48 and 60 months of age.
Exposure for the older adult women is measured at baseline, 3, 6, 12 and 18 months post-randomization, and in Guatemala and India, when the child is 24 months old.
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Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Change in Carbon monoxide (CO) exposure
Zeitfenster: Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Personal monitoring equipment is used to assess exposure to carbon monoxide (CO) over a 24-hour period in intervention and control participants (pregnant women, older adult women, and children).
Exposure for pregnant women is measured at baseline, 24-28 weeks gestation, 32-36 weeks gestation, and in Guatemala and India, when the child is 24 months old.
Exposure for the child is measured at 3, 6, 12, 24, 36, 48 and 60 months of age.
Exposure for the older adult women is measured at baseline, 3, 6, 12 and 18 months post-randomization, and in Guatemala and India, when the child is 24 months old.
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Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Change in Black carbon (BC) exposure
Zeitfenster: Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Personal monitoring equipment is used to assess exposure to black carbon (BC) over a 24-hour period in intervention and control participants (pregnant women, older adult women, and children).
Exposure for pregnant women is measured at baseline, 24-28 weeks gestation, 32-36 weeks gestation, and in Guatemala and India, when the child is 24 months old.
Exposure for the child is measured at 3, 6, 12, 24, 36, 48 and 60 months of age.
Exposure for the older adult women is measured at baseline, 3, 6, 12 and 18 months post-randomization, and in Guatemala and India, when the child is 24 months old.
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Baseline, 3, 6, 9, 12 and 18 months post-randomization, and at 24, 36, 48, 60 months of age of the child
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Messenger Ribonucleic Acid (mRNA) Expression and microRNA in Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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Two buccal cell scrapes will be collected by gently scraping the buccal mucosa on both sides of the mouth with a small plastic collection spoon.
Nasal turbinate brush samples can be collected using a soft cytobrush on each turbinate.
Collection is gentle and causes no discomfort to study participants.
Both samples will be processed in the laboratory according to procedures detailed in the protocol.
This will occur in the older adult women in an NCI substudy.
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Baseline, 18 months post-randomization
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Microbiome Operational Taxonomic Units (OTUs) in Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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For the oral rinse, participants will vigorously rinse their mouth and the rinsates are collected in a centrifuge tube.
The tube is centrifuged and the pellet and supernatant are removed to separate cryovials, labeled and frozen.
This will occur in the older adult women in an NCI substudy.
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Baseline, 18 months post-randomization
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Epigenetics (DNA methylation) in Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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Two buccal cell scrapes will be collected by gently scraping the buccal mucosa on both sides of the mouth with a small plastic collection spoon.
A 5-mL venous blood sample will be collected in an ethylenediaminetetraacetic acid (EDTA) vacutainer tube by standard clinical venipuncture of a cubital vein.
Both samples will be transported and processed in the laboratory according to procedures detailed in the protocol.
This will occur in the older adult women in an NCI substudy.
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Baseline, 18 months post-randomization
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Metabolomics and MicroRNA in Older Adult Women
Zeitfenster: Baseline, 18 months post-randomization
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A 5-mL venous blood sample will be collected in an EDTA vacutainer tube by standard clinical venipuncture of a cubital vein.
The sample will be transported and processed in the laboratory according to procedures detailed in the protocol.
This will occur in the older adult women in an NCI substudy.
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Baseline, 18 months post-randomization
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Dietary diversity - infants
Zeitfenster: 9, 12, 15 and 18 months post-randomization (3, 6, 9, and 12 months of age)
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Minimum dietary diversity for children will be measured using the World Health Organization (WHO) infant and young child feeding questionnaire.
The questionnaire uses a combination of open and closed recall and asks caregivers to report on foods and beverages consumed by the infant or young child during the previous day and night.
Responses will be categorized into eight food groups and infants who consumed five or more out of ten eight food groups will be categorized as achieving minimum dietary diversity.
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9, 12, 15 and 18 months post-randomization (3, 6, 9, and 12 months of age)
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Carotid intima-media thickness (CIMT) Among Older Adult Women During Extended Follow-up
Zeitfenster: 24 months of age of the child
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The carotid intima-media thickness test (CIMT) is used to determine the extent of carotid atherosclerotic vascular disease.
The test measures the thickness of the inner two layers of the carotid artery and can detect plaque build up prior to physical symptoms being experienced.
The carotid ultrasound will be performed with a portable ultrasound by trained sonographers.
This outcome is only assessed in Guatemala during the extended follow-up period (after the birth of the household child).
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24 months of age of the child
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Reported Diarrhea in Children
Zeitfenster: Up to 12 months after birth
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Reported diarrhea will be extracted from the Monthly Child Health Status Visit case report form.
Each month, the child's caretaker will be administered a survey to obtain information on whether the child under 1 year of age (the HAPIN study index child) or any other child in the home under 5 has experienced WHO-defined diarrhea (defined as three or more loose stools that can take the shape of a container within a 24-hour period) in the past 7 days.
Persistent diarrhea will be defined as 14 or more continuous days of diarrhea.
The presence of blood in the stool will also be noted as an indicator of severity.
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Up to 12 months after birth
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Mitarbeiter und Ermittler
Sponsor
Mitarbeiter
Ermittler
- Hauptermittler: Thomas Clasen, PhD, Emory University
- Hauptermittler: Jennifer Peel, PhD, Colorado State University
- Hauptermittler: William Checkley, MD PhD, Johns Hopkins School of Medicine
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Kearns KA, Naeher LP, McCracken JP, Boyd Barr D, Saikawa E, Hengstermann M, Mollinedo E, Panuwet P, Yakimavets V, Lee GE, Thompson LM. Estimating personal exposures to household air pollution and plastic garbage burning among adolescent girls in Jalapa, Guatemala. Chemosphere. 2024 Jan;348:140705. doi: 10.1016/j.chemosphere.2023.140705. Epub 2023 Nov 17.
- Younger A, Ye W, Alkon A, Harknett K, Kirby MA, Elon L, Lovvorn AE, Wang J, Diaz-Artiga A, McCracken JP, Castanaza Gonzalez A, Alarcon LM, Mukeshimana A, Rosa G, Chiang M, Balakrishnan K, Garg SS, Pillarisetti A, Piedrahita R, Johnson MA, Craik R, Papageorghiou AT, Toenjes A, Williams KN, Underhill LJ, Hartinger SM, Nicolaou L, Chang HH, Naeher LP, Rosenthal J, Checkley W, Peel JL, Clasen TF, Thompson LM; Household Air Pollution Intervention Network (HAPIN) Investigators. Effects of a liquefied petroleum gas stove intervention on stillbirth, congenital anomalies and neonatal mortality: A multi-country household air pollution intervention network trial. Environ Pollut. 2024 Mar 15;345:123414. doi: 10.1016/j.envpol.2024.123414. Epub 2024 Jan 27.
- Pillarisetti A, Ye W, Balakrishnan K, Rosa G, Diaz-Artiga A, Underhill LJ, Steenland K, Peel JL, Kirby MA, McCracken J, Waller L, Chang H, Wang J, Dusabimana E, Ndagijimana F, Sambandam S, Mukhopadhyay K, Kearns KA, Campbell D, Kremer J, Rosenthal J, Ghosh A, Clark M, Checkley W, Clasen T, Naeher L, Piedrahita R, Johnson M. Post-birth exposure contrasts for children during the Household Air Pollution Intervention Network randomized controlled trial. medRxiv [Preprint]. 2023 Jul 6:2023.07.04.23292226. doi: 10.1101/2023.07.04.23292226.
- Simkovich SM, Hossen S, McCollum ED, Toenjes AK, McCracken JP, Thompson LM, Castanaza A, Diaz A, Rosa G, Kirby MA, Mukeshimana A, Myers R, Lenzen PM, Craik R, Jabbarzadeh S, Elon L, Garg SS, Balakrishnan K, Thangavel G, Peel JL, Clasen TF, Davila-Roman VG, Papageorghiou AT, de las Fuentes L, Checkley W; HAPIN Investigators. Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial. Ultrasound Med Biol. 2023 May;49(5):1194-1201. doi: 10.1016/j.ultrasmedbio.2023.01.005. Epub 2023 Feb 19.
- Williams KN, Quinn A, North H, Wang J, Pillarisetti A, Thompson LM, Diaz-Artiga A, Balakrishnan K, Thangavel G, Rosa G, Ndagijimana F, Underhill LJ, Kirby MA, Puzzolo E, Hossen S, Waller LA, Peel JL, Rosenthal JP, Clasen TF, Harvey SA, Checkley W; HAPIN Investigators. Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial. Environ Int. 2023 Sep;179:108160. doi: 10.1016/j.envint.2023.108160. Epub 2023 Aug 19.
- Younger A, Alkon A, Harknett K, Kirby MA, Elon L, Lovvorn AE, Wang J, Ye W, Diaz-Artiga A, McCracken JP, Castanaza Gonzalez A, Monroy Alarcon L, Mukeshimana A, Rosa G, Chiang M, Balakrishnan K, Garg SS, Pillarisetti A, Piedrahita R, Johnson M, Craik R, Papageorghiou AT, Toenjes A, Quinn A, Williams KN, Underhill L, Chang HH, Naeher LP, Rosenthal J, Checkley W, Peel JL, Clasen TF, Thompson LM; HAPIN investigators. Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN). Environ Int. 2023 Aug;178:108059. doi: 10.1016/j.envint.2023.108059. Epub 2023 Jun 28.
- Checkley W, Hossen S, Rosa G, Thompson LM, McCracken JP, Diaz-Artiga A, Balakrishnan K, Simkovich SM, Underhill LJ, Nicolaou L, Hartinger SM, Davila-Roman VG, Kirby MA, Clasen TF, Rosenthal J, Peel JL, On Behalf Of Household Air Pollution Intervention Network Hapin Investigators. Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial. Int J Environ Res Public Health. 2022 Mar 23;19(7):3790. doi: 10.3390/ijerph19073790.
- Hennessee I, Kirby MA, Misago X, Mupfasoni J, Clasen T, Kitron U, Rosenthal JP, Hakizimana E. Assessing the Effects of Cooking Fuels on Anopheles Mosquito Behavior: An Experimental Study in Rural Rwanda. Am J Trop Med Hyg. 2022 Feb 21;106(4):1196-1208. doi: 10.4269/ajtmh.21-0997. Print 2022 Apr 6.
- Johnson M, Pillarisetti A, Piedrahita R, Balakrishnan K, Peel JL, Steenland K, Underhill LJ, Rosa G, Kirby MA, Diaz-Artiga A, McCracken J, Clark ML, Waller L, Chang HH, Wang J, Dusabimana E, Ndagijimana F, Sambandam S, Mukhopadhyay K, Kearns KA, Campbell D, Kremer J, Rosenthal JP, Checkley W, Clasen T, Naeher L; the Household Air Pollution Intervention Network (HAPIN) Trial Investigators. Exposure Contrasts of Pregnant Women during the Household Air Pollution Intervention Network Randomized Controlled Trial. Environ Health Perspect. 2022 Sep;130(9):97005. doi: 10.1289/EHP10295. Epub 2022 Sep 16.
- Kaufman JD. Invited Perspective: A Critical Part of a Real-World Environmental Health Trial Is to Demonstrate That the Intervention Reduced Exposure. Environ Health Perspect. 2022 Sep;130(9):91304. doi: 10.1289/EHP11697. Epub 2022 Sep 16. No abstract available.
- Rajamani KD, Sambandam S, Mukhopadhyay K, Puttaswamy N, Thangavel G, Natesan D, Ramasamy R, Sendhil S, Natarajan A, Aravindalochan V, Pillarisetti A, Johnson M, Rosenthal J, Steenland K, Piedhrahita R, Peel J, Clark ML, Boyd Barr D, Rajkumar S, Young B, Jabbarzadeh S, Rosa G, Kirby M, Underhill LJ, Diaz-Artiga A, Lovvorn A, Checkley W, Clasen T, Balakrishnan K. Visualizing Field Data Collection Procedures of Exposure and Biomarker Assessments for the Household Air Pollution Intervention Network Trial in India. J Vis Exp. 2022 Dec 23;(190). doi: 10.3791/64144.
- Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T; HAPIN Investigators. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. Environ Res. 2022 May 15;208:112756. doi: 10.1016/j.envres.2022.112756. Epub 2022 Jan 20.
- Ye W, Steenland K, Quinn A, Liao J, Balakrishnan K, Rosa G, Ndagijimana F, Ntivuguruzwa JD, Thompson LM, McCracken JP, Diaz-Artiga A, Rosenthal JP, Papageorghiou A, Davila-Roman VG, Pillarisetti A, Johnson M, Wang J, Nicolaou L, Checkley W, Peel JL, Clasen TF; Household Air Pollution Intervention Network (HAPIN) trial Investigators. Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial. Hypertension. 2022 Aug;79(8):1887-1898. doi: 10.1161/HYPERTENSIONAHA.122.19362. Epub 2022 Jun 16.
- Hengstermann M, Diaz-Artiga A, Otzoy-Sucuc R, Laura Maria Ruiz-Aguilar A, Thompson LM; HAPIN Investigators. Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala. Health Educ Behav. 2021 Oct;48(5):651-669. doi: 10.1177/1090198121996280. Epub 2021 Mar 18.
- Liao J, Kirby MA, Pillarisetti A, Piedrahita R, Balakrishnan K, Sambandam S, Mukhopadhyay K, Ye W, Rosa G, Majorin F, Dusabimana E, Ndagijimana F, McCracken JP, Mollinedo E, de Leon O, Diaz-Artiga A, Thompson LM, Kearns KA, Naeher L, Rosenthal J, Clark ML, Steenland K, Waller LA, Checkley W, Peel JL, Clasen T, Johnson M; HAPIN Investigators. LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial. Environ Pollut. 2021 Dec 15;291:118198. doi: 10.1016/j.envpol.2021.118198. Epub 2021 Sep 21.
- Quinn AK, Williams KN, Thompson LM, Harvey SA, Piedrahita R, Wang J, Quinn C, Pillarisetti A, McCracken JP, Rosenthal JP, Kirby MA, Diaz Artiga A, Thangavel G, Rosa G, Miranda JJ, Checkley W, Peel JL, Clasen TF. Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Nov 29;18(23):12592. doi: 10.3390/ijerph182312592.
- Simkovich SM, Underhill LJ, Kirby MA, Crocker ME, Goodman D, McCracken JP, Thompson LM, Diaz-Artiga A, Castanaza-Gonzalez A, Garg SS, Balakrishnan K, Thangavel G, Rosa G, Peel JL, Clasen TF, McCollum ED, Checkley W; HAPIN Investigators. Resources and Geographic Access to Care for Severe Pediatric Pneumonia in Four Resource-limited Settings. Am J Respir Crit Care Med. 2022 Jan 15;205(2):183-197. doi: 10.1164/rccm.202104-1013OC.
- Barr DB, Puttaswamy N, Jaacks LM, Steenland K, Rajkumar S, Gupton S, Ryan PB, Balakrishnan K, Peel JL, Checkley W, Clasen T, Clark ML; (HAPIN Investigative Team). Design and Rationale of the Biomarker Center of the Household Air Pollution Intervention Network (HAPIN) Trial. Environ Health Perspect. 2020 Apr;128(4):47010. doi: 10.1289/EHP5751. Epub 2020 Apr 29.
- Burrowes VJ, Piedrahita R, Pillarisetti A, Underhill LJ, Fandino-Del-Rio M, Johnson M, Kephart JL, Hartinger SM, Steenland K, Naeher L, Kearns K, Peel JL, Clark ML, Checkley W; HAPIN Investigators. Comparison of next-generation portable pollution monitors to measure exposure to PM2.5 from household air pollution in Puno, Peru. Indoor Air. 2020 May;30(3):445-458. doi: 10.1111/ina.12638. Epub 2020 Jan 23.
- Clasen T, Checkley W, Peel JL, Balakrishnan K, McCracken JP, Rosa G, Thompson LM, Barr DB, Clark ML, Johnson MA, Waller LA, Jaacks LM, Steenland K, Miranda JJ, Chang HH, Kim DY, McCollum ED, Davila-Roman VG, Papageorghiou A, Rosenthal JP; HAPIN Investigators. 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. Environ Health Perspect. 2020 Apr;128(4):47008. doi: 10.1289/EHP6407. Epub 2020 Apr 29.
- Crocker ME, Hossen S, Goodman D, Simkovich SM, Kirby M, Thompson LM, Rosa G, Garg SS, Thangavel G, McCollum ED, Peel J, Clasen T, Checkley W; HAPIN Investigators. Effects of high altitude on respiratory rate and oxygen saturation reference values in healthy infants and children younger than 2 years in four countries: a cross-sectional study. Lancet Glob Health. 2020 Mar;8(3):e362-e373. doi: 10.1016/S2214-109X(19)30543-1.
- Johnson MA, Steenland K, Piedrahita R, Clark ML, Pillarisetti A, Balakrishnan K, Peel JL, Naeher LP, Liao J, Wilson D, Sarnat J, Underhill LJ, Burrowes V, McCracken JP, Rosa G, Rosenthal J, Sambandam S, de Leon O, Kirby MA, Kearns K, Checkley W, Clasen T; HAPIN Investigators. Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial. Environ Health Perspect. 2020 Apr;128(4):47009. doi: 10.1289/EHP6422. Epub 2020 Apr 29.
- Puttaswamy N, Saidam S, Rajendran G, Arumugam K, Gupton S, Williams EW, Johnson CL, Panuwet P, Rajkumar S, Clark ML, Peel JL, Checkley W, Clasen T, Balakrishnan K, Barr DB. Cross-validation of biomonitoring methods for polycyclic aromatic hydrocarbon metabolites in human urine: Results from the formative phase of the Household Air Pollution Intervention Network (HAPIN) trial in India. J Chromatogr B Analyt Technol Biomed Life Sci. 2020 Oct 1;1154:122284. doi: 10.1016/j.jchromb.2020.122284. Epub 2020 Jul 29.
- Sambandam S, Mukhopadhyay K, Sendhil S, Ye W, Pillarisetti A, Thangavel G, Natesan D, Ramasamy R, Natarajan A, Aravindalochanan V, Vinayagamoorthi A, Sivavadivel S, Uma Maheswari R, Balakrishnan L, Gayatri S, Nargunanathan S, Madhavan S, Puttaswamy N, Garg SS, Quinn A, Rosenthal J, Johnson M, Liao J, Steenland K, Piedhrahita R, Peel J, Checkley W, Clasen T, Balakrishnan K. Exposure contrasts associated with a liquefied petroleum gas (LPG) intervention at potential field sites for the multi-country household air pollution intervention network (HAPIN) trial in India: results from pilot phase activities in rural Tamil Nadu. BMC Public Health. 2020 Nov 26;20(1):1799. doi: 10.1186/s12889-020-09865-1.
- Simkovich SM, Underhill LJ, Kirby MA, Goodman D, Crocker ME, Hossen S, McCracken JP, de Leon O, Thompson LM, Garg SS, Balakrishnan K, Thangavel G, Rosa G, Peel JL, Clasen TF, McCollum ED, Checkley W. Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial. ERJ Open Res. 2020 Mar 23;6(1):00308-2019. doi: 10.1183/23120541.00308-2019. eCollection 2020 Jan.
- Williams KN, Thompson LM, Sakas Z, Hengstermann M, Quinn A, Diaz-Artiga A, Thangavel G, Puzzolo E, Rosa G, Balakrishnan K, Peel J, Checkley W, Clasen TF, Miranda JJ, Rosenthal JP, Harvey SA; Household Air Pollution Intervention Network (HAPIN) trial Investigators; HAPIN Investigators. 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. BMJ Open. 2020 Sep 29;10(9):e037761. doi: 10.1136/bmjopen-2020-037761.
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- Checkley W, Thompson LM, Sinharoy SS, Hossen S, Moulton LH, Chang HH, Waller L, Steenland K, Rosa G, Mukeshimana A, Ndagijimana F, McCracken JP, Diaz-Artiga A, Balakrishnan K, Garg SS, Thangavel G, Aravindalochanan V, Hartinger SM, Chiang M, Kirby MA, Papageorghiou AT, Ramakrishnan U, Williams KN, Nicolaou L, Johnson M, Pillarisetti A, Rosenthal J, Underhill LJ, Wang J, Jabbarzadeh S, Chen Y, Davila-Roman VG, Naeher LP, McCollum ED, Peel JL, Clasen TF; HAPIN Investigators. Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants. N Engl J Med. 2024 Jan 4;390(1):44-54. doi: 10.1056/NEJMoa2302687.
- McCollum ED, McCracken JP, Kirby MA, Grajeda LM, Hossen S, Moulton LH, Simkovich SM, Goodman-Palmer D, Rosa G, Mukeshimana A, Balakrishnan K, Thangavel G, Garg SS, Castanaza A, Thompson LM, Diaz-Artiga A, Papageorghiou AT, Davila-Roman VG, Underhill LJ, Hartinger SM, Williams KN, Nicolaou L, Chang HH, Lovvorn AE, Rosenthal JP, Pillarisetti A, Ye W, Naeher LP, Johnson MA, Waller LA, Jabbarzadeh S, Wang J, Chen Y, Steenland K, Clasen TF, Peel JL, Checkley W; HAPIN Investigators. Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia. N Engl J Med. 2024 Jan 4;390(1):32-43. doi: 10.1056/NEJMoa2305681.
- Balakrishnan K, Steenland K, Clasen T, Chang H, Johnson M, Pillarisetti A, Ye W, Naeher LP, Diaz-Artiga A, McCracken JP, Thompson LM, Rosa G, Kirby MA, Thangavel G, Sambandam S, Mukhopadhyay K, Puttaswamy N, Aravindalochanan V, Garg S, Ndagijimana F, Hartinger S, Underhill LJ, Kearns KA, Campbell D, Kremer J, Waller L, Jabbarzadeh S, Wang J, Chen Y, Rosenthal J, Quinn A, Papageorghiou AT, Ramakrishnan U, Howards PP, Checkley W, Peel JL; HAPIN Investigators. Exposure-response relationships for personal exposure to fine particulate matter (PM2.5), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial. Lancet Planet Health. 2023 May;7(5):e387-e396. doi: 10.1016/S2542-5196(23)00052-9.
- Clasen TF, Chang HH, Thompson LM, Kirby MA, Balakrishnan K, Diaz-Artiga A, McCracken JP, Rosa G, Steenland K, Younger A, Aravindalochanan V, Barr DB, Castanaza A, Chen Y, Chiang M, Clark ML, Garg S, Hartinger S, Jabbarzadeh S, Johnson MA, Kim DY, Lovvorn AE, McCollum ED, Monroy L, Moulton LH, Mukeshimana A, Mukhopadhyay K, Naeher LP, Ndagijimana F, Papageorghiou A, Piedrahita R, Pillarisetti A, Puttaswamy N, Quinn A, Ramakrishnan U, Sambandam S, Sinharoy SS, Thangavel G, Underhill LJ, Waller LA, Wang J, Williams KN, Rosenthal JP, Checkley W, Peel JL; HAPIN Investigators. Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight. N Engl J Med. 2022 Nov 10;387(19):1735-1746. doi: 10.1056/NEJMoa2206734. Epub 2022 Oct 10.
- Simkovich SM, Thompson LM, Clark M, Balakrishnan K, Bussalleu A, Checkley W, Clasen T, Davila-Roman V, Diaz-Artiga A, de las Fuentes L, Harvey S, Kirby M, Lovvorn A, McCollum E, Peel J, Quinn A, Rosa G, Underhill L, Williams K, Young B, Rosenthal J. A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic. Res Sq [Preprint]. 2020 Nov 12:rs.3.rs-103997. doi: 10.21203/rs.3.rs-103997/v1.
- Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, McCracken JP, Davila-Roman V, de las Fuentes L, Quinn AK, Clark M, Diaz A, Pillarisetti A, Steenland K, Waller LA, Jabbarzadeh S, Peel JL, Checkley W; HAPIN Investigators. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. Environ Res. 2022 Nov;214(Pt 4):114121. doi: 10.1016/j.envres.2022.114121. Epub 2022 Aug 24.
- Davila-Roman VG, Toenjes AK, Meyers RM, Lenzen PM, Simkovich SM, Herrera P, Fung E, Papageorghiou AT, Craik R, McCracken JP, Thompson LM, Balakrishnan K, Rosa G, Peel J, Clasen TF, Hossen S, Checkley W, de las Fuentes L; HAPIN Investigators. Ultrasound Core Laboratory for the Household Air Pollution Intervention Network Trial: Standardized Training and Image Management for Field Studies Using Portable Ultrasound in Fetal, Lung, and Vascular Evaluations. Ultrasound Med Biol. 2021 Jun;47(6):1506-1513. doi: 10.1016/j.ultrasmedbio.2021.02.015. Epub 2021 Apr 1.
- Simkovich SM, Thompson LM, Clark ML, Balakrishnan K, Bussalleu A, Checkley W, Clasen T, Davila-Roman VG, Diaz-Artiga A, Dusabimana E, de las Fuentes L, Harvey S, Kirby MA, Lovvorn A, McCollum ED, Mollinedo EE, Peel JL, Quinn A, Rosa G, Underhill LJ, Williams KN, Young BN, Rosenthal J; HAPIN Investigators. A risk assessment tool for resumption of research activities during the COVID-19 pandemic for field trials in low resource settings. BMC Med Res Methodol. 2021 Apr 12;21(1):68. doi: 10.1186/s12874-021-01232-x.
- Liao J, McCracken JP, Piedrahita R, Thompson L, Mollinedo E, Canuz E, De Leon O, Diaz-Artiga A, Johnson M, Clark M, Pillarisetti A, Kearns K, Naeher L, Steenland K, Checkley W, Peel J, Clasen TF; HAPIN investigators. The use of bluetooth low energy Beacon systems to estimate indirect personal exposure to household air pollution. J Expo Sci Environ Epidemiol. 2020 Nov;30(6):990-1000. doi: 10.1038/s41370-019-0172-z. Epub 2019 Sep 26.
- Pillarisetti A, Ye W, Peel JL, Chang H, Underhill LJ, Balakrishnan K, Diaz-Artiga A, McCracken JP, Rosa G, Thompson LM, Aravindalochanan V, Boyd Barr D, Chen Y, Chiang M, Clark ML, Davila-Roman V, Jabbarzadeh S, Johnson MA, Kirby MA, Lovvorn AE, Naeher LP, Ndagijimana F, Piedrahita R, Puttaswamy N, Waller LA, Wang J, Williams KN, Nicolaou L, Checkley W, Clasen TF, Rosenthal JP, Steenland K; HAPIN Investigators. Household air pollution and blood pressure among adult women participants of the Household Air Pollution Intervention Network Trial: An exposure-response analysis. Environ Res. 2025 Nov 15;285(Pt 5):122570. doi: 10.1016/j.envres.2025.122570. Epub 2025 Aug 12.
- Sivalogan K, Stein AD, Thompson LM, Wang J, Diaz-Artiga A, Aravindalochanan V, Jabbarzadeh S, Nicolaou L, Williams KN, Balakrishnan K, Peel JL, Checkley W, Clasen T, Sinharoy SS; HAPIN investigators. Provision of a liquefied petroleum gas cookstove and fuel during pregnancy and infancy and linear growth trajectories between birth and 12 months: evidence from the multi-center Household Air Pollution Intervention Network (HAPIN) trial. medRxiv [Preprint]. 2025 Jun 6:2025.06.05.25329099. doi: 10.1101/2025.06.05.25329099.
- Quinn A, Hengstermann M, Diaz-Artiga A, Pillarisetti A, Clark M, Ruiz-Aguilar L, Ndagijimana F, McCracken JP, Rosa G, Checkley W, Peel J, Clasen TF, Thompson L; HAPIN Investigators. Development of personal air pollution exposure report-back materials to Household Air Pollution Intervention Network (HAPIN) trial participants in Guatemala and Rwanda: a qualitative study. BMJ Glob Health. 2025 May 15;10(5):e017672. doi: 10.1136/bmjgh-2024-017672.
- Raheel H, Sinharoy S, Diaz-Artiga A, Garg SS, Pillarisetti A, Balakrishnan K, Chiang M, Lovvorn A, Kirby M, Ramakrishnan U, Jabbarzadeh S, Mukeshimana A, Johnson M, McCracken JP, Naeher LP, Rosa G, Wang J, Rosenthal J, Checkley W, Clasen TF, Peel JL, Thompson LM; Household Air Pollution Intervention Network (HAPIN) investigators. Effects of a liquefied petroleum gas stove and fuel intervention on head circumference and length at birth: A multi-country household air pollution intervention network (HAPIN) trial. Environ Int. 2025 Jan;195:109211. doi: 10.1016/j.envint.2024.109211. Epub 2024 Dec 24.
- Patil SS, Puttaswamy N, Cardenas A, Barr DB, Ghosh S, Balakrishnan K. Protocol for CARES-HAPIN: an ambidirectional cohort study on exposure to environmental tobacco smoke and risk of early childhood caries. BMJ Open. 2024 May 15;14(5):e083874. doi: 10.1136/bmjopen-2024-083874.
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- Mollinedo E, McCracken JP, Johnson M, Piedrahita R, Pillarisetti A, Waller LA, Wang J, Thompson LM, Diaz-Artiga A, de Leon O, Ramirez A, Polanco A, Campbell D, Kearns KA, Kremer J, Nicolaou L, Clark ML, Balakrishnan K, Rosa G, Peel JL, Checkley W, Clasen TF, Naeher LP. Comparing Performance and Reliability of Collocated Enhanced Children's MicroPEM (ECM) on Gravimetric and Nephelometric PM2.5 Personal Exposure Samples in Field Measurements in Rural Guatemala. Indoor Air. 2025;2025:8812602. doi: 10.1155/ina/8812602. Epub 2025 Jan 2.
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- IRB00089799
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