TPS 641: Policies, interventions, communication, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: Three billion individuals worldwide rely on biomass fuel for cooking and heating, and health conditions resulting from household air pollution (HAP) are responsible for an estimated 3.9 million avoidable deaths annually. The conditions under which individuals sustain use of clean cookstoves are not well understood. Methods: The Enhancing LPG Adoption in Ghana (ELAG) study was a factorial cluster-randomized intervention trial targeting mothers in Kintampo, Ghana. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. RANAS aligns these five behavioral factors with clean cookstove adoption and sustained use. A second intervention improved LPG availability by offering a direct-delivery refueling service with no delivery fee. The interventions were integrated via a factorial design. 27 communities were assigned to: the control arm, the educational intervention, the delivery, or a combined intervention. Outcome measures include pre/post assessments on the RANAS model behavioral factors and minutes of stove use in the last 6 months of ELAG, tracked with stove use monitors. Results: A total of 780 participants were enrolled and randomized across four arms: 218 in the control arm, 196 to the educational intervention, 193 for direct delivery of fuel, and 173 to the combined intervention. Participants were tracked for a range of 10-12 months. There was a mean of 0.2 and a range of 0-5 self-reported cylinder refillings across the cohort. Conclusion: Recipients of improved or clean cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can lead to HAP reductions and improvements in public health.