Fuel for Life: Domestic Cooking Fuels and Women’s Health in Rural China
Abstract
:1. Introduction
2. Prior Studies
2.1. Fuel-Based HAP and Respiratory Diseases
2.2. Fuel-Based HAP and Non-Respiratory Diseases
3. Data and Methods
3.1. Study Population
3.2. Health Measures
3.3. Household Cooking Fuels (HCF)
3.4. Independent Variables
3.5. Estimation Approaches
4. Results
4.1. Descriptive Statistics
4.2. Cross-Sectional Evidence of HCF and Health: The CFPS and the CHNS
4.3. Panel Evidence for HCF and Health: The CFPS
4.4. Panel Evidence for HCF and Health: The CHNS
4.5. HCF and Major Risk Predictors of Cardiovascular Diseases (CVD): The CHNS
4.6. HCF and Specific Symptoms of Chronic or Acute Diseases
5. Discussion
5.1. Key Findings
5.2. Limitations
5.3. Future Research Directions
6. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Appendix A
Independent Variables | Definitions |
---|---|
Individual characteristics | |
Age | Years of age |
Working status | 1, if the respondent is currently employed and 0 otherwise. |
Education levels | Measured on a 6-point scale recoded as a dummy variable: 1 = illiterate, 2 = primary school, 3 = middle school, 4 = high school, 5 = vocational school and 6 = university or higher. |
Marital status | 1, if the respondent is married/living together with a partner and 0 if the respondent is divorced/separated/widowed. |
Currently smoking | 1, if the respondent has smoked in the past month and 0 otherwise. |
Time spent cooking | In the CHNS, based on the interview question: “During the previous week, how much time (in hours) did you spend per day, on average, cooking food for the household?”. |
Family characteristics | |
Household cooking fuels | Measured on a 3-point scale, 0 = wood/straw, 1 = coal and 2 = liquefied petroleum gas (LPG), based on the interview question: “What kind of fuel does you household normally use for cooking?”. |
Household income | Total amount of household income (in Yuan, adjusted to 2012 in the CFPS and to 2011 in the CHNS). |
Household size | Number of people in the household. |
Drinking water | In the CFPS, 1 if the household’s drinking source is tap water or mineral/purified water, 0 otherwise. In the CHNS, 1 if the household’s water source is a water plant or ground water above 5 m deep, 0 otherwise. |
Electricity | In the CFPS, 1 if the household has occasional or no power outage, 0 otherwise. In the CHNS, 1 if electric facilities are accessible for the household, 0 otherwise. |
Flushing toilet | In the CFPS, 1 if the household mostly use an indoor/outdoor flushing toilet, 0 otherwise. In the CHNS, 1 if the household can access an in-house/out-house flushing toilet facility, 0 otherwise. |
Clean trash treatment | In the CFPS, 1 if the household dumps the trash in the public dustbin/garbage can, 0 otherwise. |
Existence of excreta | In the CHNS, 1 if there is no excreta around the dwelling place, 0 otherwise. |
Community Characteristics | |
Location of ealth facility | In the CHNS, the availability of health facilities in the community is defined by a dummy variable equal to 1 if a health facility is located in the village/neighbourhood and 0 if in another village/town/city or in the respondent’s city but in a different neighbourhood. |
Distance to the health facility | Distance (in km) in the community to the nearest health facility like hospital/medical center. |
Health Measures | Description | Definition | Data Source | Years | Methodology |
---|---|---|---|---|---|
Self-reported acute/chronic disease | Have you felt any physical discomfort during the preceding two weeks? | A binary variable equal to 1 if the respondent has felt discomfort, and 0 otherwise. | CFPS | 2010–2012 | Probit model Random effect probit model |
Have you suffered from a chronic or acute disease during the past 4 weeks? | A dummy that equals 1 if the respondent has suffered from a chronic or acute disease, and 0 otherwise. | CHNS | 1991–2009 | Probit model Random effect probit model | |
Self-reported health (SRH) | How would you rate your health status? 1 = excellent, 2 = very good, 3 = good, 4 = fair and 5 = poor. | A 5-point scale ranging from 1 = poor to 5 = excellent. | CFPS | 2010–2012 | Ordered probit model Random effect ordered probit model |
Right now, how would you describe your health compared to that of other people your age? 1 = bad; 2 = fair; 3 = good; 4 = excellent. | A 4-point scale ranging from 1 = bad to 4 = excellent. | CHNS | 1997–2006 | Ordered probit model Random effect ordered probit model | |
Systolic blood pressure (SBP) | Measurements are taken three times by a health professional using a mercury sphygmomanometer. | The average value of SBP based on the second and third measurements. | CHNS | 1991–2009 | Ordinary least squares model Fixed effect model |
Diastolic blood pressure (DBP) | Measurements are taken three times by a health professional using a mercury sphygmomanometer. | The average value of SBP based on the second and third measurements. | CHNS | 1991–2009 | Ordinary least square model Fixed effect model |
Inflammation | Using high sensitivity C-reactive protein. | A dummy equal to 1 if the high sensitivity C-reactive protein exceeds 3 mg/dL, 0 otherwise. | CHNS | 2009 | Probit model |
Variable | CFPS | CHNS | ||
---|---|---|---|---|
(1) | (2) | (3) | (4) | |
16–50 | 50+ | 16–50 | 50+ | |
Coal | 0.010 | 0.027 ** | 0.016 | 0.003 |
(0.015) | (0.012) | (0.012) | (0.006) | |
95% CI | [−0.020, 0.039] | [0.004, 0.050] | [−0.008, 0.041] | [−0.009, 0.015] |
LPG | 0.025 ** | 0.035 *** | 0.014 | 0.022 *** |
(0.012) | (0.011) | (0.013) | (0.007) | |
95% CI | [0.002, 0.048] | [0.014, 0.056] | [−0.011, 0.038] | [0.008, 0.037] |
N | 7958 | 4945 | 5107 | 3302 |
Pseudo R2 | 0.140 | 0.109 | 0.052 | 0.042 |
Variable | Random Effects Ordered Probit: 16–50 | Random Effects Ordered Probit: 50+ |
---|---|---|
Coal | 0.021 | 0.024 * |
(0.016) | (0.013) | |
95% CI | [−0.011, 0.052] | [−0.001, 0.048] |
LPG | 0.012 | 0.027 *** |
(0.011) | (0.009) | |
95% CI | [−0.010, 0.033] | [0.009, 0.046] |
N | 6011 | 3989 |
Variable | Chronic/Acute Disease | Self-Reported Health (Excellent) |
---|---|---|
Random Effects Probit | Random Effects Ordered Probit | |
Coal | −0.007 | 0.002 |
(0.006) | (0.005) | |
95% CI | [−0.019, 0.005] | [−0.008, 0.012] |
LPG | −0.013 | 0.022 *** |
(0.009) | (0.006) | |
95% CI | [−0.029, 0.004] | [0.009, 0.034] |
1 ≤ TSC < 2 h/day | −0.003 | −0.005 |
(0.008) | (0.006) | |
95% CI | [−0.018, 0.012] | [−0.016, 0.006] |
2 ≤ TSC < 3 h/day | −0.011 | 0.003 |
(0.008) | (0.006) | |
95% CI | [−0.027, 0.005] | [−0.010, 0.015] |
TSC ≥ 3 h/day | −0.012 | −0.011 |
(0.009) | (0.008) | |
95% CI | [−0.029, 0.006] | [−0.026, 0.004] |
Number of surveyed years | 0.001 | −0.0005 |
(0.002) | (0.002) | |
95% CI | [−0.003, 0.005] | [−0.004, 0.003] |
N | 10,090 | 7023 |
Variable | Random Effects Ordered Probit: 16–50 | Random Effects Ordered Probit: 50+ |
---|---|---|
Coal | −0.001 | 0.005 |
(0.009) | (0.004) | |
95% CI | [−0.019, 0.017] | [−0.004, 0.013] |
LPG | 0.020 * | 0.020 *** |
(0.011) | (0.006) | |
95% CI | [−0.002, 0.041] | [0.008, 0.031] |
1 ≤ TSC < 2 h/day | 0.001 | −0.007 |
(0.010) | (0.005) | |
95% CI | [−0.019, 0.020] | [−0.016, 0.003] |
2 ≤ TSC < 3 h/day | 0.007 | −0.001 |
(0.011) | (0.005) | |
95% CI | [−0.015, 0.029] | [−0.012, 0.009] |
TSC ≥ 3 h/day | −0.001 | −0.014 ** |
(0.013) | (0.007) | |
95% CI | [−0.027, 0.026] | [−0.028, −0.001] |
N | 4085 | 2938 |
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Variable | N | Mean | Std. Dev. | Min | Max |
---|---|---|---|---|---|
Dependent variable | |||||
Chronic/acute disease | 12,901 | 0.347 | 0.476 | 0 | 1 |
Fever | 12,901 | 0.022 | 0.147 | 0 | 1 |
Pain | 12,901 | 0.156 | 0.363 | 0 | 1 |
Cough | 12,901 | 0.015 | 0.121 | 0 | 1 |
Palpitation | 12,901 | 0.033 | 0.177 | 0 | 1 |
Self-reported health (SRH) | |||||
Poor | 12,901 | 0.146 | 0.353 | 0 | 1 |
Fair | 12,901 | 0.154 | 0.361 | 0 | 1 |
Good | 12,901 | 0.171 | 0.376 | 0 | 1 |
Very good | 12,901 | 0.262 | 0.440 | 0 | 1 |
Excellent | 12,901 | 0.267 | 0.443 | 0 | 1 |
Household cooking fuels | |||||
Wood/straw | 12,901 | 0.637 | 0.481 | 0 | 1 |
Coal | 12,901 | 0.106 | 0.308 | 0 | 1 |
liquefied petroleum gas (LPG) | 12,901 | 0.257 | 0.437 | 0 | 1 |
Individual characteristics | |||||
Age | 12,901 | 46.059 | 16.053 | 16 | 97 |
Working status | 12,901 | 0.490 | 0.500 | 0 | 1 |
Education levels | |||||
Illiterate | 12,901 | 0.516 | 0.500 | 0 | 1 |
Primary school | 12,901 | 0.220 | 0.414 | 0 | 1 |
Middle school | 12,901 | 0.194 | 0.395 | 0 | 1 |
High school | 12,901 | 0.052 | 0.223 | 0 | 1 |
Vocational school | 12,901 | 0.012 | 0.110 | 0 | 1 |
University or higher | 12,901 | 0.005 | 0.073 | 0 | 1 |
Marital status | 12,901 | 0.834 | 0.372 | 0 | 1 |
Currently smoking | 12,901 | 0.039 | 0.195 | 0 | 1 |
Family characteristics | |||||
Household income (log) | 12,901 | 9.877 | 1.148 | 0.693 | 14.253 |
Household size | 12,901 | 4.674 | 1.922 | 1 | 26 |
Drinking water | 12,901 | 0.421 | 0.494 | 0 | 1 |
Electricity | 12,901 | 0.944 | 0.230 | 0 | 1 |
Flushing toilet | 12,901 | 0.209 | 0.407 | 0 | 1 |
Clean trash treatment | 12,901 | 0.148 | 0.355 | 0 | 1 |
Community Characteristics | |||||
Distance to the health facility (km) | 12,901 | 1.247 | 1.670 | 0.001 | 9.500 |
Variable | N | Mean | Std. Dev. | Min | Max |
---|---|---|---|---|---|
Dependent variable | |||||
Chronic/acute disease | 15,539 | 0.109 | 0.311 | 0 | 1 |
Fever | 15,539 | 0.046 | 0.210 | 0 | 1 |
Asthma | 1078 | 0.001 | 0.031 | 0 | 1 |
Eye disease | 15,539 | 0.004 | 0.066 | 0 | 1 |
Heart disease/chest pain | 15,539 | 0.009 | 0.092 | 0 | 1 |
Self-reported health (SRH) | |||||
Bad | 8409 | 0.070 | 0.256 | 0 | 1 |
Fair | 8409 | 0.317 | 0.465 | 0 | 1 |
Good | 8409 | 0.492 | 0.500 | 0 | 1 |
Excellent | 8409 | 0.121 | 0.326 | 0 | 1 |
Household cooking fuels | |||||
Wood/straw | 15,539 | 0.409 | 0.492 | 0 | 1 |
Coal | 15,539 | 0.420 | 0.494 | 0 | 1 |
liquefied petroleum gas (LPG) | 15,539 | 0.171 | 0.377 | 0 | 1 |
Individual characteristics | |||||
Age | 15539 | 44.959 | 15.728 | 16 | 97.84 |
Working status | 15539 | 0.705 | 0.456 | 0 | 1 |
Education levels | |||||
Illiterate | 15,539 | 0.300 | 0.458 | 0 | 1 |
Primary school | 15,539 | 0.337 | 0.473 | 0 | 1 |
Middle school | 15,539 | 0.263 | 0.440 | 0 | 1 |
High school | 15,539 | 0.073 | 0.260 | 0 | 1 |
Vocational school | 15,539 | 0.020 | 0.140 | 0 | 1 |
University or higher | 15,539 | 0.007 | 0.083 | 0 | 1 |
Marital status | 15,539 | 0.799 | 0.400 | 0 | 1 |
Currently smoking | 15,539 | 0.037 | 0.189 | 0 | 1 |
Time spent cooking (hours/day) | 10,227 | 1.728 | 0.932 | 0.017 | 4.667 |
Family characteristics | |||||
Household income (log) | 15,539 | 9.390 | 1.011 | 1.156 | 13.414 |
Household size | 15,539 | 4.198 | 1.591 | 1 | 13 |
Water | 15,539 | 0.827 | 0.378 | 0 | 1 |
Flushing toilet | 15,539 | 0.207 | 0.405 | 0 | 1 |
No excreta around the dwelling place | 15,539 | 0.568 | 0.495 | 0 | 1 |
Electricity | 15,539 | 0.984 | 0.127 | 0 | 1 |
Community characteristics | |||||
Location of health facility | 15,539 | 0.752 | 0.432 | 0 | 1 |
Distance to the health facility (km) | 15,539 | 0.923 | 3.573 | 0 | 60 |
Variable | CFPS | CHNS | ||
---|---|---|---|---|
(1) | (2) | (3) | (4) | |
Chronic/Acute Disease | Self-Reported Health (Excellent) | Chronic/Acute Disease | Self-Reported Health (Excellent) | |
Coal | 0.010 | 0.019 * | −0.008 | 0.009 |
(0.020) | (0.011) | (0.008) | (0.007) | |
95% CI | [−0.030, 0.050] | [−0.002, 0.040] | [−0.025, 0.008] | [−0.005, 0.023] |
LPG | −0.044 *** | 0.029 *** | −0.009 | 0.021 *** |
(0.015) | (0.009) | (0.010) | (0.008) | |
95% CI | [−0.075, −0.014] | [0.012, 0.046] | [−0.028, 0.010] | [0.006, 0.037] |
N | 12,901 | 12,901 | 15,539 | 8409 |
Pseudo R2 | 0.065 | 0.147 | 0.090 | 0.081 |
Variable | Random Effects Probit (1) Chronic/Acute Disease | Random Effects Ordered Probit (2) Self-Reported Health (Excellent) |
---|---|---|
Coal | −0.006 | 0.023 ** |
(0.020) | (0.010) | |
95% CI | [−0.046, 0.034] | [0.003, 0.044] |
LPG | −0.052 *** | 0.020 *** |
(0.015) | (0.007) | |
95% CI | [−0.081, −0.024] | [0.006, 0.035] |
N | 9770 | 10,000 |
Variable | Random Effects Probit (1) Chronic/Acute Disease | Random Effects Ordered Probit (2) Self-Reported Health (Excellent) |
---|---|---|
Coal | −0.007 | 0.002 |
(0.006) | (0.005) | |
95% CI | [−0.019, 0.005] | [−0.008, 0.012] |
LPG | −0.013 | 0.022 *** |
(0.008) | (0.006) | |
95% CI | [−0.030, 0.004] | [0.009, 0.034] |
1 ≤ TSC < 2 h/day | −0.003 | −0.005 |
(0.008) | (0.006) | |
95% CI | [−0.018, 0.011] | [−0.016, 0.006] |
2 ≤ TSC < 3 h/day | −0.011 | 0.003 |
(0.008) | (0.006) | |
95% CI | [−0.027, 0.005] | [−0.010, 0.015] |
TSC ≥ 3 h/day | −0.012 | −0.011 |
(0.009) | (0.008) | |
95% CI | [−0.029, 0.006] | [−0.026, 0.004] |
N | 10,090 | 7023 |
Variable | OLS Estimate | Probit Estimate | |||
---|---|---|---|---|---|
16–50 | 50+ | 16–50 | 50+ | ||
Systolic Blood Pressure | Diastolic Blood Pressure | Inflammation | |||
(1) | (2) | (3) | (4) | (5) | |
Coal | 0.110 | 2.295 * | 0.567 | 0.957 | 0.025 |
(0.703) | (1.282) | (0.453) | (0.760) | (0.032) | |
95% CI | [−1.279, 1.499] | [−0.239, 4.829] | [−0.329, 1.462] | [−0.545, 2.459] | [−0.037, 0.088] |
LPG | 0.345 | 0.936 | 0.512 | 0.873 | 0.021 |
(0.750) | (1.427) | (0.480) | (0.841) | (0.032) | |
95% CI | [−1.138, 1.828] | [−1.883, 3.755] | [−0.437, 1.460] | [−0.789, 2.535] | [−0.041, 0.083] |
N | 6389 | 3838 | 6389 | 3838 | 1637 |
Pseudo/Adjusted R2 | 0.146 | 0.109 | 0.128 | 0.062 | 0.058 |
Variable | Systolic Blood Pressure | Diastolic Blood Pressure | ||
---|---|---|---|---|
(1) | (2) | (3) | (4) | |
16–50 | 50+ | 16–50 | 50+ | |
Coal | −0.599 | 2.267 * | 0.288 | 0.079 |
(0.669) | (1.229) | (0.481) | (0.707) | |
95% CI | [−1.910, 0.713] | [−0.144, 4.677] | [−0.655, 1.232] | [−1.308, 1.466] |
LPG | −0.131 | −0.573 | 0.654 | −0.215 |
(0.768) | (1.438) | (0.553) | (0.827) | |
95% CI | [−1.637, 1.375] | [−3.392, 2.246] | [−0.430, 1.738] | [−1.838, 1.407] |
1 ≤ TSC < 2 h/day | 0.524 | 1.536 | 1.076 ** | −0.111 |
(0.612) | (1.006) | (0.440) | (0.579) | |
95% CI | [−0.676, 1.724] | [−0.435, 3.508] | [0.212, 1.940] | [−1.246, 1.023] |
2 ≤ TSC < 3 h/day | −0.036 | 1.731 | 0.920 * | −0.110 |
(0.664) | (1.129) | (0.478) | (0.649) | |
95% CI | [−1.337, 1.265] | [−0.483, 3.944] | [−0.016, 1.857] | [−1.384, 1.164] |
TSC ≥ 3 h/day | −1.064 | 2.603 ** | −0.008 | 0.417 |
(0.726) | (1.300) | (0.523) | (0.748) | |
95% CI | [−2.488, 0.359] | [0.055, 5.152] | [−1.033, 1.017] | [−1.049, 1.884] |
N | 6252 | 3838 | 6252 | 3838 |
R2 | 0.088 | 0.102 | 0.066 | 0.028 |
CFPS | ||||
Variable | Fever | Cough | Pain | Palpitation |
Coal | −0.003 | 0.003 | 0.007 | 0.006 |
(0.005) | (0.004) | (0.015) | (0.005) | |
95% CI | [−0.013, 0.007] | [−0.005, 0.010] | [−0.021, 0.036] | [−0.003, 0.016] |
LPG | 0.001 | 0.003 | −0.018 | −0.008 * |
(0.004) | (0.003) | (0.012) | (0.004) | |
95% CI | [−0.006, 0.008] | [−0.003, 0.009] | [−0.041, 0.005] | [−0.017, 0.0003] |
N | 12,637 | 12,623 | 12,901 | 12,901 |
Pseudo R2 | 0.023 | 0.031 | 0.059 | 0.072 |
CHNS | ||||
Variable | Fever/Cough | Asthma | Eye | Heart/Chest Pain |
Coal | −0.003 | −0.007 | −0.003 * | 0.004 * |
(0.005) | (0.007) | (0.002) | (0.002) | |
95% CI | [−0.013, 0.007] | [−0.021, 0.006] | [−0.006, 0.0002] | [−0.0004, 0.008] |
LPG | −0.001 | −0.007 | −0.004 ** | 0.003 |
(0.006) | (0.010) | (0.002) | (0.002) | |
95% CI | [−0.012, 0.010] | [−0.027, 0.013] | [−0.008, −0.001] | [−0.002, 0.008] |
N | 15,539 | 1078 | 14,299 | 15,539 |
Pseudo R2 | 0.081 | 0.297 | 0.208 | 0.172 |
CFPS | ||||
Variable | Fever | Cough | Pain | Palpitation |
Coal | −0.002 | 0.003 | 0.001 | 0.003 |
(0.004) | (0.002) | (0.001) | (0.003) | |
95% CI | [−0.010, 0.007] | [−0.002, 0.007] | [−0.002, 0.004] | [−0.002, 0.008] |
LPG | 0.002 | −0.002 | 0.002 | −0.003 |
(0.003) | (0.002) | (0.001) | (0.002) | |
95% CI | [−0.004, 0.007] | [−0.006, 0.001] | [−0.001, 0.004] | [−0.007, 0.001] |
N | 10,002 | 10,002 | 10,002 | 10,002 |
CHNS | ||||
Variable | Fever | Eye | Heart/Chest Pain | |
Coal | −0.008 * | −0.001 | 0.001 | |
(0.004) | (0.001) | (0.001) | ||
95% CI | [−0.017, 0.00004] | [−0.003, 0.001] | [−0.001, 0.003] | |
LPG | −0.012 ** | −0.001 | 0.001 | |
(0.006) | (0.001) | (0.001) | ||
95% CI | [−0.024, −0.0003] | [−0.003, 0.001] | [−0.002, 0.003] | |
N | 10,090 | 10,090 | 10,090 |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nie, P.; Sousa-Poza, A.; Xue, J. Fuel for Life: Domestic Cooking Fuels and Women’s Health in Rural China. Int. J. Environ. Res. Public Health 2016, 13, 810. https://doi.org/10.3390/ijerph13080810
Nie P, Sousa-Poza A, Xue J. Fuel for Life: Domestic Cooking Fuels and Women’s Health in Rural China. International Journal of Environmental Research and Public Health. 2016; 13(8):810. https://doi.org/10.3390/ijerph13080810
Chicago/Turabian StyleNie, Peng, Alfonso Sousa-Poza, and Jianhong Xue. 2016. "Fuel for Life: Domestic Cooking Fuels and Women’s Health in Rural China" International Journal of Environmental Research and Public Health 13, no. 8: 810. https://doi.org/10.3390/ijerph13080810