{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:08:23Z","timestamp":1785431303072,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Valparaiso University Office of Advancement"},{"id":[{"id":"https:\/\/ror.org\/01pp0fx48","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Creative Work and Research Committee"},{"name":"Sigma Theta Tau Zeta Epsilon Chapter grants"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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 &lt; 0.0001), chest illness (p &lt; 0.0001), shortness of breath (p &lt; 0.0001), headaches (p &lt; 0.0001), and eye irritation (p &lt; 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.<\/jats:p>","DOI":"10.3390\/ijerph23050647","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:02:27Z","timestamp":1779375747000},"page":"647","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Health Outcomes in Women Who Use Traditional Open Fire Cookstoves by Addressing Cooking Behaviors: A Longitudinal Cohort Study"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-4373","authenticated-orcid":false,"given":"Amy C.","family":"Buckenmeyer","sequence":"first","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"},{"name":"School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin L.","family":"Jantzi","sequence":"additional","affiliation":[{"name":"College of Arts and Sciences, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7104-5682","authenticated-orcid":false,"given":"Deanna","family":"Marriott","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5521-9083","authenticated-orcid":false,"given":"Jeri M.","family":"Antilla","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9772-6065","authenticated-orcid":false,"given":"Vanesa","family":"Abad","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Barnes","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn","family":"Blackmon","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E.","family":"Burman","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Crave","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina E.","family":"Roembke","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8899-9263","authenticated-orcid":false,"given":"Tricia","family":"Stathakis","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1794-0513","authenticated-orcid":false,"given":"Paige A.","family":"Takalamingan","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison M.","family":"Wood","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN 46383, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eve","family":"Goddard","sequence":"additional","affiliation":[{"name":"College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Hunt","sequence":"additional","affiliation":[{"name":"College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, March 08). Household Air Pollution and Health. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/household-air-pollution-and-health."},{"key":"ref_2","unstructured":"World Health Organization (2026, March 08). Preventing Noncommunicable Diseases (NCDs) by Reducing Environmental Risk Factors. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-FWC-EPE-17.01."},{"key":"ref_3","first-page":"S18","article-title":"Estimating disease burden attributable to household air pollution: New methods within the Global Burden of Disease Study","volume":"9","author":"Bennitt","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1080\/10810730.2014.989346","article-title":"Integrating behavior change theory and measures into health-based cookstove interventions: A proposed epidemiologic research agenda","volume":"20","author":"Clark","year":"2015","journal-title":"J. Health Commun."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.erss.2018.02.015","article-title":"From cookstove acquisition to cookstove transition: Framing the behavioral aspects of cookstove interventions","volume":"42","author":"Kar","year":"2018","journal-title":"Energy Res. Soc. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1038\/sj.jea.7500355","article-title":"Impact of improved stoves, house construction and child location on levels of indoor air pollution exposure in young Guatemalan children","volume":"14","author":"Bruce","year":"2004","journal-title":"J. Expo. Anal. Envion. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/aje\/kwp100","article-title":"Effect of reducing indoor air pollution on women\u2019s respiratory symptoms and lung function: The RESIRE randomized trial, Guatemala","volume":"170","author":"Diaz","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1136\/thoraxjnl-2017-210952","article-title":"Impact of improved cookstoves on women\u2019s and child health in low- and middle-income countries: A systematic review and meta-analysis","volume":"73","author":"Thankur","year":"2018","journal-title":"Thorax"},{"key":"ref_9","unstructured":"World Bank (2026, March 09). Environmental Health in Rural Nicaragua: Addressing Key Environmental Challenges. Available online: https:\/\/openknowledge.worldbank.org\/handle\/10986\/16588."},{"key":"ref_10","unstructured":"World Bank (2026, March 09). Access to Clean Fuels and Technologies for Cooking, Rural (% of Rural Population)\u2014Nicaragua. Available online: https:\/\/data.worldbank.org\/indicator\/EG.CFT.ACCS.RU.ZS."},{"key":"ref_11","unstructured":"Cory, A.C., Thomas, K., Kost, K., Popa, B., and Erdmann, T. (2010, January 6\u201310). Beyond the volcanoes: Community assessment and action to improve health equity in rural Nicaragua. Proceedings of the Annual Meeting of the American Public Health Association, Denver, CO, USA."},{"key":"ref_12","unstructured":"Pan American Health Organization (2026, March 09). Estrategia de Cooperacion de Pais: Nicaragua, 2016\u20132021. Available online: https:\/\/www.paho.org\/es\/documentos\/estrategia-cooperacion-pais-nicaragua-2016-2021."},{"key":"ref_13","unstructured":"World Bank (2026, March 09). Strengthening the Family and Community Health Care Model in Nicaragua. Available online: https:\/\/www.worldbank.org\/en\/results\/2017\/04\/11\/strengthening-the-family-and-community-health-care-model-in-nicaragua."},{"key":"ref_14","unstructured":"Green, L.W., and Kreuter, M.W. (2005). The PRECEDE-PROCEED model. Health Program Planning: An Educational and Ecological Approach, McGraw-Hill. [4th ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19016","DOI":"10.3402\/gha.v5i0.19016","article-title":"Cooking practices, air quality, and the acceptability of advanced cookstoves in Haryana, India: An exploratory study to inform large-scale interventions","volume":"5","author":"Mukhopadhyay","year":"2012","journal-title":"Glob. Health Action"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"D\u00edaz, E., Bruce, N., Pope, D., Diaz, A., Smith, K.R., and Smith-Sivertsen, T. (2008). Self-rated health among Mayan women participating in a randomized intervention trial reducing indoor air pollution in Guatemala. BMC Int. Health Hum. Rights, 8.","DOI":"10.1186\/1472-698X-8-7"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.envint.2017.01.012","article-title":"Real-life effectiveness of \u2018improved\u2019 stoves and clean fuels in reducing PM2.5 and CO: Systematic review and meta-analysis","volume":"101","author":"Pope","year":"2017","journal-title":"Environ. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.envint.2017.03.010","article-title":"Effectiveness of interventions to reduce household air pollution and\/or improve health in home using solid fuel in low-and-middle income countries: A systematic review and meta-analysis","volume":"103","author":"Quansah","year":"2017","journal-title":"Environ. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1289\/ehp.1104194","article-title":"Who adopts improved fuels and cookstoves? A systematic review","volume":"120","author":"Lewis","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.enpol.2013.10.082","article-title":"Rethinking improved cookstove diffusion programs: A case study of perceptions and cooking choices in rural Guatemala","volume":"66","author":"Bielecki","year":"2014","journal-title":"Energy Policy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1021\/acsomega.8b03596","article-title":"Emission performance and user acceptance of a catalytic biomas cookstove in rural Guatemala","volume":"4","author":"Paulsen","year":"2019","journal-title":"ACS Omega"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1111\/ina.12460","article-title":"Usage and impacts of the Envirofit HM-5000 cookstove","volume":"28","author":"Garland","year":"2018","journal-title":"Indoor Air"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"21","DOI":"10.18865\/ed.27.1.21","article-title":"The development of health for hearts united: A longitudinal church-based intervention to reduce cardiovascular risk in mid-life in older African Americans","volume":"27","author":"Ralston","year":"2017","journal-title":"Ethn. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1037\/0022-006X.51.3.390","article-title":"Stages and processes of self-change of smoking: Toward an integrative model of change","volume":"51","author":"Prochaska","year":"1983","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_25","unstructured":"Glanz, K., Rimer, B.K., and Viswanath, K. (2015). The Transtheoretical Model and stages of change. Health Behavior and Health Education: Theory, Research, and Practice, Jossey-Bass. [5th ed.]."},{"key":"ref_26","unstructured":"Wallerstein, N., Duran, B., Oetzel, J., and Minkler, M. (2018). Community-Based Participatory Research for Health, Jossey-Bass. [3rd ed.]."},{"key":"ref_27","unstructured":"Israel, B.A., Eng, E., Schulz, A.J., and Parker, E.A. (2012). Methods in Community-Based Participatory Research for Health, Jossey-Bass. [2nd ed.]."},{"key":"ref_28","unstructured":"Cory, A.C., Erdmann, T., Schmerber, R., and Thomas, K. (2008, January 25\u201329). Beyond the volcanoes: A community partnership for health in rural Nicaragua. Proceedings of the Annual Meeting of the American Public Health Association, San Diego, CA, USA."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/0533316498312005","article-title":"Sociodrama","volume":"31","author":"Kelleran","year":"1998","journal-title":"Group Anal."},{"key":"ref_30","unstructured":"USAID (2002). House, Household, and Data Montitoring Sheet."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1093\/pubmed\/fdt086","article-title":"Ventilated cookstoves associated with improvements in respiratory health-related quality of live in rural Bolivia","volume":"36","author":"Alexander","year":"2014","journal-title":"J. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1748-0361.2012.00431.x","article-title":"Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities","volume":"29","author":"Barnidge","year":"2013","journal-title":"J. Rural Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e053320","DOI":"10.1136\/bmjopen-2021-053320","article-title":"How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: A realist review","volume":"11","author":"Nelson","year":"2012","journal-title":"BMJ Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7557","DOI":"10.1016\/j.enpol.2011.03.028","article-title":"Adoption and sustained use of improved cookstoves","volume":"39","author":"Masera","year":"2011","journal-title":"Energy Policy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1146\/annurev-publhealth-040617-014731","article-title":"The sustainability of evidence-based interventions and practices in public health and health care","volume":"39","author":"Shelton","year":"2018","journal-title":"Annu. Rev. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1111\/phn.12795","article-title":"Using behavioral science theory to enhance public health nursing","volume":"37","author":"Sleet","year":"2020","journal-title":"Public Health Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/647\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:06:53Z","timestamp":1779376013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijerph23050647"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23050647","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}