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Background: Exposure to household air pollution from cooking fires using biomass fuels (e.g., wood, charcoal, dung) is a leading cause of death and disability worldwide. Household air pollution (HAP) is one of the greatest environmental health risks in low-income and middle-income countries where the majority of people use biomass fuels to cook and heat their homes each day. Worldwide, approximately three billion people cook with biomass fuels; most often, these people cook inside homes with poor ventilation and use traditional stoves without chimneys. Even when clean-burning stoves and fuels are introduced in communities using HAP-producing cooking systems, adoption of these systems is often limited, and the use of clean-burning systems is not exclusive or sustained. To date, despite the need to understand behaviors related to smoke from cooking and heating sources, few investigators have used a behavioral theory or framework as a foundation for their investigation. Methods: This qualitative exploratory study using open-ended interviews was conducted in Aleto Wondo, a rural area in southern Ethiopia. This research used grounded theory methodology and the theory of symbolic interaction to investigate the symbolic meaning that motivates actions related to exposures to household air pollution from cooking fire smoke. The target population was women who had children in the home and who primarily used biomass fuels for cooking.Results: Themes that emerged during the analysis process and that are grounded in the data were (a) Awareness, Knowledge, and Interpretation; (b) Traditional Way; (c) Perceived Powerless and Lack of Agency; (d) Opportunities for Clarification and Education; (e) Access and Poverty; and (f) God’s Will. These themes summarized the major factors in the participants’ social world—factors that influence the participant’s symbolic meanings and interpretations that affected actions related to smoke from cooking fires. Conclusions: Using the theoretical and methodological tools of grounded theory and symbolic interaction helped delineate how the themes identified in this research may each interrelate. Relative to household kitchen fire smoke exposure, human action is not overpoweringly affected by a single factor (e.g., God’s will, gender roles) Relative to household kitchen fire smoke exposure, human action cannot be ascribed to a single factor (e.g., God’s will, gender roles) or even a unique combination of known factors. These factors can be considered immutable or mutable based on an individual’s symbolic meanings and interpretive processes.