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Assessing Interventions: What Works? How Well? For How Long?

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.

Projects

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.

Publications

2022

Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study

Lu W., Wang L.A., Mann J., Jenny A., Romero C., Kuster A., Canuz E., Pillarisetti A., Smith K.R., Balmes J., Thompson L. (2022). Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study. International Journal of Environmental Research and Public Health. 2022; 19(21):14064. https://doi.org/10.3390/ijerph192114064

Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight.

Clasen, T. F., Chang, H. H., Thompson, L. M., Kirby, M. A., Balakrishnan, K., Díaz-Artiga, A., McCracken, J. P., Rosa, G., Steenland, K., Younger, A., Aravindalochanan, V., Barr, D. B., Castañaza, A., Chen, Y., Chiang, M., Clark, M. L., Garg, S., Hartinger, S., Jabbarzadeh, S., Pillarisetti, A., … Peel, J. L. (2022). Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2206734

Exposure Contrasts of Pregnant Women during the Household Air Pollution Intervention Network Randomized Controlled Trial

Johnson, M., Pillarisetti, A., Piedrahita, R., Balakrishnan, K., Peel, J. L., Steenland, K., Underhill, L. J., Rosa, G., Kirby, M. A., Díaz-Artiga, A., McCracken, J., Clark, M. L., Waller, L., Chang, H. H., Wang, J., Dusabimana, E., Ndagijimana, F., Sambandam, S., … Mukhopadhyay, K. (2022). Exposure Contrasts of Pregnant Women during the Household Air Pollution Intervention Network Randomized Controlled Trial. In Environmental Health Perspectives (Vol. 130, Issue 9). Environmental Health Perspectives. https://doi.org/10.1289/ehp10295

Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial

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.

Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India

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

2021

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.

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

LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial

Liao J, Kirby M, Pillarisetti A, et al. LPG stove and fuel intervention among pregnant women reduce fine particle air pollution exposures in three countries: Pilot results from the HAPIN trial. Environmental Pollution 2021: 118198. DOI: https://doi.org/10.1016/j.envpol.2021.118198.

Barriers to and facilitators of uptake and sustained use of LPG through the PMUY in tribal communities of Pune district

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

Modeling approaches and performance for estimating personal exposure to household air pollution: A case study in Kenya

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

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.

Sambandam, S., Mukhopadhyay, K., Sendhil, S. et al. 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 20, 1799 (2020). https://doi.org/10.1186/s12889-020-09865-1

2020

Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder

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.

Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes

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.

2019

Machine-learned modeling of PM2.5 exposures in rural Lao PDR

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.

Promoting LPG usage during pregnancy: A pilot study in rural Maharashtra, India

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)

2017

The potential health benefits of lower household air pollution after a liquefied petroleum gas (LPG) cookstove intervention

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

The Impact of Household Energy Interventions on Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis

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.

2016

Use of temperature sensors to determine exclusivity of improved stove use and associated household air pollution reductions — Kenya, 2012-2013

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.

2015

Household Air Pollution Exposures of Pregnant Women Receiving Advanced Combustion Cookstoves in India: Implications for Intervention

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

2014

Patterns of stove usage after introduction of an advanced cookstove: the long-term application of household sensors

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.

2012

Assessment of effectiveness of improved cook stoves in reducing indoor air pollution and improving health in Nepal

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.

Cooking practices, air quality, and the acceptability of advanced cookstoves in Haryana, India: an exploratory study to inform large-scale interventions.

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).

You don't get what you expect, you get what you inspect.