Research Summary
My program of research focuses on household air pollution in low-resource countries. My research uses implementation science methods to design, implement, and evaluate effective interventions that reduce personal exposures to household air pollution from cooking fires among populations burdened with health inequities related to poor access to health care. I use the National Institute of Environmental Health Services definition of “global environmental health” to refer to the improvement of health for all people with a focus on addressing preventable environmental risks, specifically household air pollution from solid fuels. This is an environmental risk that is related to women’s empowerment, environmental justice, climate change and overall global development.
I have participated as a co-investigator in several stove intervention trials, starting with the RESPIRE trial (Randomized Exposure Study of Pollution Indoors and Respiratory Effects, Dr. Kirk R Smith, PI). RESPIRE was the first randomized controlled trial of a stove intervention to address household air pollution, conducted from 2002-2005. To date, the RESPIRE trial is the most widely cited study in this field of research.
The NACER study evaluated the efficacy and feasibility of a gas stove/behavioral change intervention to reduce exposures to household air pollution among 50 pregnant women in rural Guatemala. Understanding how to influence behavior change among new stove adopters is an important area of focus when introducing new clean stove technologies. Theory-driven interventions are the cornerstone to understanding implementation of complex technologies. Using implementation science methods, we assessed the barriers and enablers at a community level to understand adoption and sustained use of liquefied petroleum gas stoves. Using concepts drawn from Michie’s COM-B model and Behavior Change Wheel, I designed an intervention around an assessment of women’s capabilities, opportunities, and motivations to use the new gas stove instead of sustained use of the woodstove.
As a result of my pioneering work in gas stove implementation and behavioral reinforcement to use the gas stoves, I was invited to participate as a co-investigator in an NIEHS/Gates Foundation-funded UM1 referred to as the Household Air Pollution Intervention Network (HAPIN) Trial (MPIs, Clasen, Checkley, Peel). The HAPIN Trial was a multi-country parallel group randomized controlled trial of a liquefied petroleum gas (LPG) stove-and-fuel intervention, complemented with behavioral messaging, on health outcomes among 3,200 pregnant women enrolled in Guatemala, India, Peru and Rwanda (2017-2022). This trial aims to improve understanding of prenatal and early life exposures to household air pollution.
In August 2021, I received NIEHS funding to conduct a hybrid type 1 village-level cluster randomized trial. We developed, and are evaluating, implementation strategies to reduce household-level plastic waste burning in rural Guatemalan indigenous communities. Household waste burning, especially of plastics, is a largely unaddressed environmental hazard in countries that lack waste management infrastructure. Burning plastic releases chemicals that can disrupt neurodevelopment, endocrine, and reproductive function. This is the first implementation science study funded by NIEHS and will develop and evaluate community-level working groups striving to eliminate a common household exposure.
Research Funding
May 15, 2023 - April 30, 2028 - Effects of Early Life Exposure to Household Air Pollution on DNA Methylation and Respiratory Disease in Guatemalan Children from the Household Air Pollution Intervention Network (HAPIN) Trial , Co-Investigator . Sponsor: NIH, Sponsor Award ID: R01HL163256
September 16, 2022 - June 30, 2026 - 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 , Co-Investigator . Sponsor: NIH, Sponsor Award ID: R01ES033530
August 18, 2021 - May 31, 2026 - Combustion of plastic waste and human health effects in Guatemala , Principal Investigator . Sponsor: NIH, Sponsor Award ID: R01ES032009
September 25, 2021 - August 31, 2022 - 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 , Co-Investigator . Sponsor: NIH, Sponsor Award ID: R56ES033530
September 22, 2016 - July 31, 2022 - Household Air Pollution and Health: A Multi-Country LPG Intervention Trial , Co-Investigator . Sponsor: NIH, Sponsor Award ID: UM1HL134590
August 15, 2015 - July 31, 2017 - Prenatal household air pollution exposure: gas stove and behavioral interventions , Principal Investigator . Sponsor: NIH, Sponsor Award ID: R21ES025032
June 1, 2001 - August 31, 2011 - Chronic respiratory effects of early life PM exposure , Co-Investigator . Sponsor: NIH, Sponsor Award ID: R01ES010178
Education
Tulane University, BA, 06/84, Latin American Studies
San Francisco State University, BS/MS, 06/91, Nursing
San Francisco State University, FNP, 06/96, Family Nurse Practitioner
University of California, Berkeley, MS, 06/04, Environmental Health Sciences
University of California, Berkeley, PhD, 06/08, Environmental Health Sciences