Geographic and socio-economic variations in markers of household air pollution in India: prevalence, determinants, and co-exposure

Household air pollution (HAP) is a notable health hazard that needs to be studied, but exposure to HAP is not well understood in developing countries like India. A sample of 600,029 households from the fourth round of the National Family Health Survey (2015–2016) was analyzed to investigate the independent and combined markers of HAP in India. The most favorable category of the markers of HAP is households (30%) that cook with clean cooking fuels (CCF) and have no exposure to environmental tobacco smoke (ETS), while the least healthy category is households (8%) that use unclean cooking fuels (UCF), cook without a separate kitchen (CWSK), and have daily exposure to ETS. There are large variations in co-exposure to HAP across the states in India, regardless of the socio-demographic group. In general, CCF use and non-exposure to ETS are higher among households in which the head has a higher level of education (65%), households in which the head belongs to the other social class (43%), lives in pucca houses (45%), and households belonging to the rich wealth quintile (62%). In the adjusted model, households belonging to disadvantaged social groups, those with low levels of education, those living in kaccha houses, and those located in rural areas had higher odds of accessing UCF, CWSK, and ETS. Overall, this study shows that as a body of knowledge, we should “scale up” the universal use of CCF, enforce strict regulations of tobacco smoke, and monitor progress to envision societal environmental and health benefits.