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
Open accessAbstract
BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: ), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.
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Modern cooking solutions such as LPG stoves and electric appliances may achieve greater exposure reductions than improved biomass stoves, but scaling them beyond trials faces challenges in fuel supply reliability and affordability.
“Modern cooking solutions such as liquid petroleum gas (LPG) stoves and electric appliances show promise for achieving greater exposure reductions41,42 compared with improved biomass stoves, but scaling these solutions beyond trial settings will present new challenges; notably those related to reliability of fuel supplies and issues around affordability 43–46.”
From Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial (2022) · cites this paper as [41]
The Discussion (page unavailable) says free fuel is an element of the HAPIN trial unlikely to be operationalized at scale, supporting the affordability concern. Methods > Intervention (page unavailable) describes continuous LPG delivery during the trial, but the paper does not explicitly establish that unreliable fuel supplies pose a challenge beyond trials. The earlier comparison of exposure reductions is attached to different citations in the citing sentence. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCooking fuels have received most of the attention with respect to global initiatives and research-based interventions focused on the health benefits of improved or cleaner cookstoves.
“Although HAP can arise from several indoor sources, cooking fuels have received most of the attention with respect to global initiatives (e.g. the Global Alliance for Clean Cookstoves supported by the United Nations, https://www.cleancookingalliance.org/)and research-based interventions focused on the health benefits of improved or cleaner cookstoves.”
From Kerosene-based lighting: an overlooked source of exposure to household air pollution? (2020) · cites this paper as Clasen et al., 2020
The Discussion (page not available in our copy) describes large-scale cookstove programs, research on stove interventions, and government efforts to promote clean cooking fuels. It does not compare attention to cooking fuels with attention to other indoor pollution sources, so the claim that they received *most* of the attention is not established. (LLM, conf=0.79)
Experimental — accuracy not yet measuredExamples of major cookstove interventions conducted in Sub-Saharan Africa include the Cooking and Pneumonia Study in rural Malawi and the Rwanda site within the HAPIN trial.
“Examples of major cookstove interventions conducted in SSA include the Cooking and Pneumonia Study in rural Malawi (Mortimer et al., 2017) and the Rwanda site within the multi-country HAPIN trial of liquefied petroleum gas (Clasen et al., 2020).”
From Kerosene-based lighting: an overlooked source of exposure to household air pollution? (2020) · cites this paper as Clasen et al., 2020
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- Authors
- Clasen, T., Checkley, W., Peel, J. L., Balakrishnan, K., McCracken, J. P., Rosa, G., Thompson, L. M., Barr, D. B., Clark, M. L., Johnson, M. A., Waller, L. A., Jaacks, L. M., Steenland, K., Miranda, J. J., Chang, H. H., Kim, D.-Y., McCollum, E. D., Davila-Roman, V. G., Papageorghiou, A., Rosenthal, J. P., & HAPIN Investigators
- Affiliations
- Emory University (US)
- Johns Hopkins University (US)
- Colorado State University (US)
- Sri Ramachandra Institute of Higher Education and Research (IN)
- Universidad del Valle de Guatemala (GT)
- London School of Hygiene & Tropical Medicine (GB)
- Berkeley Air Monitoring Group (United States) (US)
- Harvard University (US)
- Universidad Peruana Cayetano Heredia (PE)
- National Institutes of Health (US)
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
- University of Oxford (GB)
- Corresponding author
- Clasen, Thomas
- ORCID
- Clasen, Thomas
- Checkley, William
- Peel, Jennifer L.
- Balakrishnan, Kalpana
- McCracken, John P.
- Rosa, Ghislaine
- Thompson, Lisa M.
- Barr, Dana Boyd
- Clark, Maggie L.
- Johnson, Michael A.
- Waller, Lance A.
- Jaacks, Lindsay M.
- Steenland, Kyle
- Miranda, J. Jaime
- Chang, Howard H.
- Kim, Dong-Yun
- McCollum, Eric D.
- Papageorghiou, Aris
- Rosenthal, Joshua P.
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2020-04
- Volume
- 128
- Issue
- 4
- Pages
- 47008-47008
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC7228119
- OpenAlex
- W3018992794
- Cited by
- 122
- References
- 63
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 15 · 2023: 14 · 2022: 24 · 2021: 21 · 2020: 12
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Environmental Health Perspectives (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by-nc-sa)
- Funders
- Bill and Melinda Gates Foundation (OPP1131279, NCT02944682, 1UM1HL134590)
- Emory University
- Washington University in St. Louis
- Johns Hopkins University
- London School of Hygiene and Tropical Medicine
- Indian Council of Medical Research
- Universidad del Valle
- National Institutes of Health
- Centers for Disease Control and Prevention (R01CE002981)
- National Heart, Lung, and Blood Institute (UM1HL134590)
- National Cancer Institute
- Fogarty International Center
- National Institute of Environmental Health Sciences (P30ES019776)
- National Institute of Child Health and Human Development
- Office of Strategic Coordination
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Common Fund
- Topics
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- liquefied petroleum gas stoves, household air pollution, solid fuels, fuel distribution, carbon monoxide, black carbon, dried blood spots, urinary biomarkers, low- and middle-income countries, premature mortality
- MeSH terms
- Adult, Aged, Air Pollutants, Cooking, Female, Guatemala, Humans, India, Infant, Infant, Newborn, Middle Aged, Peru, Pregnancy, Rwanda, Randomized Controlled Trials as Topic, Air Pollution, Indoor, Particulate Matter, Young Adult, Natural Gas
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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