Improving Health Outcomes in Women Who Use Traditional Open Fire Cookstoves by Addressing Cooking Behaviors: A Longitudinal Cohort Study.

Approximately one-third of the global population cooks over open fires in the home, which are responsible for millions of deaths per year globally. The aim of this longitudinal cohort study was to develop, implement, and evaluate an intervention to improve the cooking behaviors of women in a rural Nicaraguan community. The study employed the Community Health Action Model for Participatory Behavior Change (CHAMP-BC) framework to develop a novel approach to improving cooking behaviors and reducing symptoms associated with household air pollution. The study was conducted from October 2007 to March 2018. Community health needs assessments and community forums were conducted. Readiness to change surveys were administered. Pre- and post-test cookstove implementation surveys were conducted. One hundred sixty-seven primary cooks, primarily women (99%), consented to participate in the improved cookstove program and were followed from baseline for up to seven years post-intervention. There were significant improvements in cough (p < 0.0001), chest illness (p < 0.0001), shortness of breath (p < 0.0001), headaches (p < 0.0001), and eye irritation (p < 0.0001). The novel CHAMP-BC framework enhanced the research approach by empowering women to change their cooking behaviors while providing them with the autonomy and agency necessary for decision-making regarding evidence-based methods to improve their health.