College of Graduate Studies: Theses & Dissertations

Term of Award

Fall 2026

Degree Name

Doctor of Public Health in Epidemiology (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

Department of Biostatistics, Epidemiology, and Environmental Health Sciences

Committee Chair

Hani Samawi

Committee Member 1

Atin Adhkari

Committee Member 2

Logan Cowan

Abstract

Background: Childhood asthma is influenced by both environmental exposures and social determinants, including household smoking and housing instability, yet population-level evidence on their combined impact remains limited. This study aims to identify the associations between household smoking exposure, housing instability, and childhood asthma across the United States.

Methodology: A population-based cross-sectional study was conducted using the National Survey of Children’s Health (NSCH) data. Children included in the study ranged in age from birth to 17 years. The risk factors and health outcomes were assessed using parents' self-reported information. Numerical variables were summarized by Mean (M) and Standard Deviation (SD), whereas categorical variables were described using frequencies (N) and percentages (%) across the dataset analyses. Descriptive statistics and logistic regression were performed to assess the association between risk factors and health outcomes. Both the crude odds ratio (COR) and adjusted odds ratio (AOR) were reported with 95% Confidence Intervals (CIs), at a p< 0.05 significance level. Statistical analyses were performed using SAS 9.4 statistical software.    

Results: This study examined the associations between household smoking, housing instability, and childhood asthma using 52,532 U.S. children’s data. Household smoking and housing instability rates were higher in Kansas (0.60%) and California (0.93%), respectively. Individual-level analyses indicated that asthma was more prevalent among males (5.67%) and White children (6.79%). Mothers with poor health, premature birth, and low birth weight children had the highest asthma prevalence (1.76%, 1.62%, and 0.29%, respectively). In the crude analysis, both household smoking (COR=1.37; 95% CI: 1.25-1.49) and housing instability (COR=1.71; 95% CI: 1.59-1.85) were statistically significantly associated with asthma (p< 0.05). In the final adjusted models, household smoking (AOR=1.12; 95% CI: 1.00-1.26) and housing instability (AOR=1.26; 95% CI: 1.13-1.40) were also statistically significant (p< 0.05). Other significant predictors included gender, Black or African American race, overweight, very low birth weight, premature birth, and maternal suboptimal health, which were also statistically significant (p< 0.05).

Conclusion: Household smoking and unstable housing significantly increased childhood asthma risk, emphasizing the need to target environmental and social factors in prevention and intervention efforts.

Research Data and Supplementary Material

No

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Available for download on Friday, September 12, 2031

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