Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial

Abstract

Background: High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru.

Objectives: The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures.

Methods: Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM $<2.5\mu m$ in aerodynamic diameter (${\mathrm{PM}}_{2.5}$)] with the Enhanced Children's MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children $<1\text{year}$ of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of ${\mathrm{PM}}_{2.5}$ exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur.

Conclusions: The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. https://doi.org/10.1289/EHP6422.

Figure 1.

Exposure assessment timeline including frequency of assessment for intervention and control households. The intervention arm will have gas stoves, whereas the control arm will use traditional biomass stoves. In each country, direct personal measurements will be collected for 800 pregnant women during gestation and an estimated 120 older women, 40–79 years of age, living in the same households. Indirect measurements of personal exposure using a microenvironmental approach will be conducted on 800 infants from birth to 1 year of age. Traditional biomass stove usage will be continuously measured by stove use monitors during the trial, whereas gas usage will be tracked by the number of cylinders used by each household throughout the trial. Note: BC, black carbon; CO, carbon monoxide; LPG, liquid petroleum gas; ${\mathrm{PM}}_{2.5}$, particulate matter $<2.5\mathrm{\mu }\mathrm{m}$ in aerodynamic diameter.

Figure 2.

(A) Enhanced Children’s MicroPEM™ (ECM) developed by RTI International; (B) CO data logger, model EL-USB-300 (Lascar Electronics); (C) E-Sampler (Met One Instruments) installed in the Peru site; Beacon (Model O Roximity Inc.); (D) Beacon Logger (Berkeley Air Monitoring Group); and (E) Geocene stove use monitors (Geocene). [Photo credits: Michael Johnson (A), Ricardo Piedrahita (B), Ajay Pillarisetti (C), and Ricardo Piedrahita (D), and Daniel Wilson (E).]

Figure 3.

Example photos of participants wearing customized vests and/or aprons with exposure monitoring equipment. (A) Guatemala; (B) India; (C) Peru; and (D) Rwanda. The picture of the sampling garment in Guatemala was taken when a pump and cyclone setup was also being compared with the Enhanced Children’s MicroPEM™ (ECM) during Household Air Pollution Intervention Network (HAPIN)’s formative research phase. [Photo credits: Eric Mollinedo (A), Thangavel Gurusamy (B), Vanessa Burrowes (C), and Ephrem Dusabimana (D)].