R01HL157091

Community Mobilization for Improved Clean Cookstove Uptake, Household Air Pollution Reduction, and Hypertension Prevention - Project Summary

Annually, 4.3 million premature deaths are attributable to household air pollution (HAP) from solid fuels used for cooking. In Nigeria, 90 million households cook with solid fuels. The use of clean (i.e. high-efficiency and low emission) cookstoves can reduce HAP and improve health outcomes.

In our randomized controlled trial (RCT) of 271 women in Nigeria, the use of "clean fuel-clean-stove" (CF-CS) versus kerosene-based stoves led to significant blood pressure (BP) reduction and an 80% adoption rate. However, its widespread adoption is sub-optimal in Africa because these countries often lack the expertise needed to coordinate system changes to implement evidence-based practices without assistance.

A community mobilization (CM) strategy may overcome this barrier because it builds community readiness and support for normative changes. Thus, CM may enhance the demand for CF-CS use by modifying community barriers to its adoption.

In collaboration with the Lagos State Ministry of Health (MOH), we will develop a context-specific CM strategy and evaluate its effects on the adoption and sustainability of affordable bioethanol-based CF-CS use in Lagos, Nigeria. The CM strategy includes:
1) Community Advisory Board (of local organizations, government officials, and residents) that will provide leadership support and buy-in for the adoption of CF-CS use.
2) Trained Community Health Extension Workers [from the MOH] who will facilitate proper household use of CF-CS through Community Action Teams (CATS).
3) Community dialogues that are focused on shared concerns regarding CF-CS use in households.

Using a focused implementation research framework, the EPIS (Exploration, Preparation, Implementation, and Sustainment) model, in a Type-2 hybrid design, we will conduct this study in three phases:
1) A pre-implementation phase that will explore barriers and facilitators of CF-CS use and develop a CM strategy for CF-CS use.
2) An implementation phase to compare, in a cluster RCT, the effect of CM vs. a self-directed condition (i.e. receipt of information on CF-CS without CM) on the adoption of CF-CS use and systolic BP reduction.
3) A post-implementation phase that will compare the effect of CM strategy vs. self-directed condition on the sustainability of CF-CS use in peri-urban communities in Lagos.

Aim 1: To conduct a needs assessment on community readiness for the adoption of CF-CS use in peri-urban communities in Lagos; develop and pilot test a culturally-tailored CM strategy.
Aim 2: To compare, in a cluster RCT of 32 peri-urban communities, the effect of CM vs. self-directed condition on the adoption of CF-CS use in 640 households.
Aim 3: To compare the effect of CM vs. self-directed condition on systolic BP reduction.
Aim 4: To evaluate the sustainability of CF-CS use one year after completion of the trial.

The primary outcome is adoption of CF-CS use, defined as utilization of CF-CS for more than 50% of cooking activities in the household, measured with iButtons stove usage monitors. The secondary outcomes are mean change in systolic BP from baseline to 12 months and sustainability of CF-CS use (maintenance of adoption at 24 months), one year after the trial.

New York University

TO FOSTER HEART AND VASCULAR RESEARCH IN THE BASIC, TRANSLATIONAL, CLINICAL AND POPULATION SCIENCES, AND TO FOSTER TRAINING TO BUILD TALENTED YOUNG INVESTIGATORS IN THESE AREAS, FUNDED THROUGH COMPETITIVE RESEARCH TRAINING GRANTS. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION, USE SMALL BUSINESS TO MEET FEDERAL RESEARCH AND DEVELOPMENT NEEDS, FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY SOCIALLY AND ECONOMICALLY DISADVANTAGED PERSONS, AND INCREASE PRIVATE-SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION, FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE R&D BETWEEN SMALL BUSINESSES AND RESEARCH INSTITUTIONS, AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL R&D.

93.837 - Cardiovascular Diseases Research

National Heart Lung and Blood Institute (NHLBI) [HHS - NIH]

New York, New York 100165267 United States

Single Zip Code

Dissemination and Implementation Research in Health (R01 Clinical Trial Optional) (PAR-19-274)

Amendment Since initial award the total obligations have increased 442% from $727,224 to $3,941,241.