Assessing Interventions: What Works? How Well? For How Long?
Interventions to decrease household air pollution exposures have a long history, ranging from so-called ‘improved’ biomass stoves that burn available fuels cleanly to clean fuels, like liquefied petroleum gas and ethanol, to electricity. Our group works on evaluating interventions from cost, environmental, climate, and health perspectives.
Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial
The Household Air Pollution Intervention Network (HAPIN) Trial is an international multi-center study aimed at assessing the impact of a liquefied petroleum gas (LPG) cooking stove and fuel intervention on health. HAPIN Trial centers are located in four countries: Guatemala, India, Peru and Rwanda.
The HAPIN Trial was launched in 2017 with formative research. Main trial enrollment started in 2018 and follow-up of participants ended in September 2021. More than 7,200 study participants were enrolled and will help the HAPIN Trial find answers to questions about LPG cookstoves and health. Currently the investigators are analyzing data for the primary outcomes: low birth weight, severe pneumonia incidence, and stunting in the child, and blood pressure in the older adult woman. Secondary outcomes include preterm birth and child development in the child, maternal blood pressure during pregnancy, and endothelial function, respiratory impairment, atherosclerosis, carcinogenic metabolites, and quality of life in the older adult woman. The team has been publishing manuscripts throughout project implementation.
The trial is funded by the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation. Participating NIH components are the National Heart, Lung, and Blood Institute (NHLBI), the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Environmental Health Sciences, the NIH Common Fund of the NIH Office of the Director, and the Fogarty International Center. NHLBI leads administration of the trial on behalf of the consortium. The Global LPG Partnership provides expert advice. We are thankful for the guidance of our advisory committee: Patrick Brysse, Donna Spiegelman, and Joel Kaufman.
Targeting Pregnancy and Marriage with Clean Fuels: A Pilot Study in Maharashtra, India
In Maharashtra, India, we collaborated with Sri Ramachandra Institute of Higher Education and Research (SRIHER) and KEM Hospital Research Centre to provide clean fuels to pregnant women, recruited in the late first or early second trimester, in Pune district, Maharashtra, India. Our study sought to evaluate whether fuel use could be incentivized using a conditional cash transfer and, additionally, what the benefit and cost of providing free fuel during pregnancy would be in terms of pollution exposure reduction and exclusive use of clean fuels. Our study had multiple arms: one in which household received a clean LPG stove and two cylinders of fuel; one in which household were paid for their LPG use, using a novel conditional cash transfer sensor; and one in which households received free fuel for the duration of pregnancy (up to one free refill per month). Finally, we sought to assess the feasibility of targeting newly wed couples prior to conception; we did so because reducing exposures in the first trimesters is thought to be critical. Findings from the study, which was funded by the Clean Cooking Implementation Science Network, were extensively published.
Newborn Stove Project (NBSP)
NBSP – a partnership between the International Clinical Epidemiology Network (INCLEN), Columbia University, UC Berkeley, and Sri Ramachandra Institute for Higher Education and Research (SRIHER) – evaluated the feasibility of distributing clean cookstoves through the rural antenatal care system, which targets arguably the most vulnerable population — poor, pregnant, rural women. The study distributed 200 blower stoves to pregnant women at INCLEN’s SOMAARTH field site and tracked usage of the stoves continuously for > 15 months using our Stove Use Monitoring System (SUMS) and measured pollutant concentrations and exposures before and after introduction of the stove. Funding for this project came from the United States Centers for Disease Control and Prevention, the World Lung Foundation, and the World Bank.
Evaluating a clean cookstove intervention program in Lao PDR
With colleagues at Berkeley Air Monitoring Group, the World Bank, and LIRE (Vientiane), we are developing standard methods for estimating the health benefits (in the form of ADALYs – avoided disability-adjusted life years) that can be attributed to a stove project to introduce advanced combustion stoves in villages within the Savannakhet region of Laos. This project, led by L. Drew Hill, PhD, involved air pollution field work before and after the introduction of the stoves, modeling changes in personal exposure to PM2.5, and using the Household Air Pollution Intervention Tool (HAPIT) to calculate the estimated change in adult and child disease rates that would result.
Ye W, Steenland K, Quinn A, Liao J, Balakrishnan K, Rosa G, Ndagijimana F, Ntivuguruzwa JD, Thompson LM, McCracken JP, Díaz-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. (2022). Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial. Hypertension.
Ye W, Thangavel G, Pillarisetti A, Steenland NK, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T, HAPIN Investigators. (2022) “Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India.” Environmental Research 208 112756. https://doi.org/10.1016/j.envres.2022.112756
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 on behalf of HAPIN Investigators. 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. International Journal of Environmental Research and Public Health. 2021; 18(23):12592. https://doi.org/10.3390/ijerph182312592
Patil R, Roy S, Gore M, Ghorpade M, Pillarisetti A, Chakma J, Juvekar S. Barriers to and facilitators of uptake and sustained use of LPG through the PMUY in tribal communities of Pune district. Energy for Sustainable Development 2021. doi.org/10.1016/j.esd.2021.04.008
Johnson, M., Piedrahita, R., Pillarisetti, A., Shupler, M., Menya, D., Rossanese, M., Delapeña, S., Penumetcha, N., Chartier, R., Puzzolo, E. and Pope, D. (2021), Modeling approaches and performance for estimating personal exposure to household air pollution: A case study in Kenya. Indoor Air. https://doi.org/10.1111/ina.12790
Harrell S, Pillarisetti A, Roy S, Ghorpade M, Patil R, Dhongade A, Smith KR, Levine DI, Juvekar S. Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder. Environ. Sci. Technol. 2020; 54(23):15313-15319. doi: 10.1021/acs.est.0c01818.
Pillarisetti A, Roy S, Diamond-Smith N, Ghorpade M, Dhongade A, Balakrishnan K, Sambandam S, Patil R, Levine D, Juvekar S, Smith K. Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes. BMJ Open. 2020/10; 10(10):e044127. doi: 10.1136/bmjopen-2020-044127.
Hill LD, Pillarisetti A, Delapena S, Garland C, Pennise D, Pelletreau A, Koetting P, Motmans T, Vongnakhone K, Khammavong C, Boatman MR, Balmes K, Hubbard A, Smith Kr. 2019. Machine-learned modeling of PM2.5 exposures in rural Lao PDR. Science of The Total Environment, https://doi.org/10.1016/j.scitotenv.2019.04.258.
Pillarisetti A*, Ghorpade M, Madhav S, Dhongade A, Roy S, Balakrishnan K, Sankar S, Patil R, Levine DI, Juvekar S, Smith KR (2019) Promoting LPG usage during pregnancy: A pilot study in rural Maharashtra, India. Environment International 127:540-549. Supporting Information (.docx)
Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang H, Clasen T. 2018. The potential health benefits of lower household air pollution after a liquefied petroleum gas (LPG) cookstove intervention. Environment International 111:71-79. doi.org/10.1016/j.envint.2017.11.018
Pillarisetti A*, Jamison D, Smith KR. 2017. The Impact of Household Energy Interventions on Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis. In C. Mock, O. Kobusingye, R. Nugent, K. R. Smith (Eds.), Injury Prevention & Environmental Health, Disease Control Priorities, third edition, volume 7. Washington, DC: World Bank.
Lozier MJ, Sircar K, Christensen B, Pillarisetti A, Pennise D, Bruce N, Stanistreet D, Naeher L, Pilishvili T, Farrar JL, Sage M, Nyagol R, Muoki J, Wochuck T, Yip F. 2016. Use of temperature sensors to determine exclusivity of improved stove use and associated household air pollution reductions — Kenya, 2012-2013. Environmental Science & Technology. doi:10.1021/acs.est.5b06141.
Balakrishnan K, Sambandam S, Ghosh S, Mukhopadhyay K, Vaswani M, Arora NK, Jack D, Pillarisetti A, Bates MN, Smith KR. Household Air Pollution Exposures of Pregnant Women Receiving Advanced Combustion Cookstoves in India: Implications for Intervention. Annals of Global Health, In Press, http://dx.doi.org/10.1016/j.aogh.2015.08.009
Pillarisetti, A.; Vaswani, M.; Jack, D.; Balakrishnan, K.; Bates, M. N.; Arora, N. K.; Smith, K. R. Patterns of Stove Usage after Introduction of an Advanced Cookstove: The Long-Term Application of Household Sensors. Environ. Sci. Technol. 2014, 48, 14525-14533.
Ashish Singh, Bhushan Tuladhar, Karuna Bajracharya, Ajay Pillarisetti, Assessment of effectiveness of improved cook stoves in reducing indoor air pollution and improving health in Nepal, Energy for Sustainable Development, Available online 24 October 2012, ISSN 0973-0826, 10.1016/j.esd.2012.09.004.
Mukhopadhyay R, Sambandam S, Pillarisetti A, Jack D, Mukhopadhyay K, Balakrishnan K, Vaswani M, Bates MN, Kinney PL, Arora NK, Smith KR. Cooking practices, air quality, and the acceptability of advanced cookstoves in Haryana, India: an exploratory study to inform large-scale interventions. Glob Health Action. 2012 Sep.5; 5(0).