Assessing the 5-Year Effects of a 500-day Liquefied Petroleum Gas Cooking Intervention: Continued Follow up of Participants from the Household Air Pollution Intervention Network (HAPIN) trial

近30亿人继续使用固体燃料（煤、生物质、动物粪便）满足家庭能源需求， 主要是在低收入和中等收入国家。使用固体燃料烹饪造成的家庭空气污染 据估计，每年有230万人过早死亡，并造成额外的发病负担。 家庭使用固体燃料（二氧化碳和炭黑）烹饪产生的空气污染排放也很大 全球一级的气候变暖气体来源。家庭空气污染干预网络（HAPIN） 一项试验（NIH UM 1HL 134590）正在评估免费LPG（液化石油气）炉和燃料的效果 对4个国家（危地马拉、印度、秘鲁、卢旺达）各800名孕妇进行分娩干预 结果和1岁以下儿童健康;数据收集已扩展到2岁。审判 实现了出色的保留（92%），高坚持干预，并大大减少了个人 暴露于细颗粒物（PM2.5）和黑碳是气候变化的一个因素。初步结果 表明干预改善了出生时的身长和体重。研究表明， 在妊娠和生命早期，与一系列长期结果有关， 即使干预结束，暴露仍将继续。因此，我们建议继续跟进HAPIN儿童 到5岁，以评估原始HAPIN干预对神经和身体发育的影响 (Aim 1）。此外，鉴于干预在1岁时结束，我们将继续描述儿童的个人特征， 暴露于PM2.5和黑碳（目标2），使我们能够评估 妊娠和幼儿期的几个相关时期（目标3）。HAPIN试验具有独特的优势， 解决这些问题，在试验期间进行大的暴露对比，并生成丰富的数据集， 考虑到控制家庭和所有家庭之间暴露的预期异质性， 参与者在试用后采用了LMIC环境中典型的各种燃料和烹饪方法。所选 卫生成果得到以往文献的支持，对政策具有重要意义。我们的总体 假设是：1）原始干预对神经和身体发育有长期益处 干预结束后，2）在关键发育期间， 月经周期与神经和身体发育呈负相关。我们建议探讨这些 在危地马拉、印度和卢旺达的HAPIN儿童中的目标和假设（n= 2，175名儿童留在3个国家）， 研究地点）。拟议的工作建立在HAPIN试验中已经进行的主要投资的基础上， 干预的益处是否超出怀孕和孩子的第一年生活， 在3种不同的环境中进行了充分表征的队列，为问题提供了严格且广泛可推广的答案 对科学和政策都很重要。我们正在通过扩展我们先前的研究来最大限度地提高成功的潜力， 使用一个经验丰富和经过验证的研究团队，与参与者建立牢固和持续的关系。

Nearly 3 billion people continue to use solid fuels (coal, biomass, animal dung) for household energy needs, primarily in low- and middle-income countries. The household air pollution resulting from cooking with solid fuels is responsible for an estimated 2.3 million premature deaths and additional morbidity burden each year. Household air pollution emissions from cooking with solid fuels (carbon dioxide and black carbon) are also major sources of climate warming gases at the global level. Our Household Air Pollution Intervention Network (HAPIN) trial (NIH UM1HL134590) is evaluating the effect of a free LPG (liquefied petroleum gas) stove and fuel intervention among 800 pregnant women in each of 4 countries (Guatemala, India, Peru, Rwanda) on birth outcomes and child health through age 1; data collection has been extended through age 2. The trial has achieved excellent retention (92%), high adherence to the intervention, and a substantial reduction in personal exposure to fine particulate matter (PM2.5) and black carbon, a contributor to climate change. Preliminary results suggest the intervention improves length and weight at birth. Research suggests that exposure experienced during gestation and early life is linked to a range of longer-term outcomes, and that the benefits of reduced exposure will continue even if the intervention ends. Therefore, we propose to continue to follow HAPIN children through age 5 to evaluate the effects of the original HAPIN intervention on neurologic and physical development (Aim 1). Further, given that the intervention ends at age 1, we will continue to characterize the children’s personal exposure to PM2.5 and black carbon (Aim 2), allowing us the unique ability to evaluate exposure-response for several relevant periods of gestation and early childhood (Aim 3). The HAPIN trial is uniquely positioned to address these questions, with a large exposure contrast during the trial and the generation of a rich dataset to examine exposure-response given the expected heterogeneity in exposures among control households and all participants post-trial as they adopt the various fuels and cooking practices typical in LMIC settings. The selected health outcomes are supported by previous literature and have important implications for policy. Our overarching hypotheses are that 1) the original intervention has longer term benefits for neurologic and physical development after the intervention ends, and 2) that personal exposure to PM2.5 and black carbon during critical developmental periods will be inversely associated with neurologic and physical development. We propose to explore these aims and hypotheses in HAPIN children in Guatemala, India, and Rwanda (n=2,175 children remaining in the 3 study sites). The proposed work builds on the major investment already made in the HAPIN trial by evaluating whether the benefits of the intervention extend beyond pregnancy and the child’s first year of life, leveraging a well-characterized cohort in 3 diverse settings, providing rigorous and widely generalizable answers to questions important for both science and policy. We are maximizing potential for success by extending our prior research, using an experienced and proven research team, with strong and ongoing relationships with participants.