ABSTRACT
BACKGROUND: Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. OBJECTIVE: Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. METHODS: We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ≤2.5µm (PM2.5), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. RESULTS: Baseline mean [±standard deviation (SD)] PM2.5 (kitchen area concentrations 1,220±1,010 vs. 1,190±880 µg/m3; personal exposure 126±214 vs. 104±100 µg/m3), CO (kitchen 53±49 vs. 50±41 ppm; personal 7±8 vs. 7±8 ppm), and BC (kitchen 180±120 vs. 210±150 µg/m3; personal 19±16 vs. 21±22 µg/m3) were similar between control and intervention participants. Intervention participants had consistently lower mean (±SD) concentrations at the 12-month visit for kitchen (41±59 µg/m3, 3±6 µg/m3, and 8±13 ppm) and personal exposures (26±34 µg/m3, 2±3 µg/m3, and 3±4 ppm) to PM2.5, BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 34±74 µg/m3, 3±5 µg/m3, and 6±6 ppm and personal exposures of 17±15 µg/m3, 2±2 µg/m3, and 3±4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 561±1,251 µg/m3, 82±124 µg/m3, and 23±28 ppm and personal exposures of 35±38 µg/m3, 6±6 µg/m3, and 4±5 ppm, respectively). DISCUSSION: Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.