Date of Completion


Embargo Period



David Gregorio, Michelle Cloutier

Field of Study

Public Health


Master of Public Health

Open Access

Open Access


Background: Secondhand tobacco smoke exposure (STSE) has been associated with an increased incidence of asthma exacerbations, but the relationship between STSE and asthma severity is less clear.

Objective: To determine whether STSE is associated with asthma severity in children living in Connecticut who have physician-diagnosed asthma and to examine whether it is modified by common markers of community-level socioeconomic status (SES) using the Five Connecticuts study.

Methods: The Easy Breathing database identified 32,691 children with physician-diagnosed asthma living in 161 towns in Connecticut. This large database was linked by participant zip code to census data, allowing classification by community, with the five categories described in the Five Connecticuts study were used as proxies for levels of SES. Statistical analysis involved multinomial logistic regression models adjusted for enrollment date, sex, age, race/ethnicity, community type, insurance type, family history of asthma, eczema, and exposure to secondhand tobacco smoke, dogs, cats, gas stove, rodents, and cockroaches. We modeled asthma severity according to the standard classification system of mild persistent, moderate persistent, severe persistent, or intermittent asthma subtypes.

Results: For the Easy Breathing program participant, STSE was significantly associated with mild and moderate persistent asthma (aRRR: 1.09 [1.02, 1.17] and aRRR: 1.11 [1.02, 1.21] respectively). In analyses stratified by STSE, race/ethnicity (p=0.004) and insurance type (p

Conclusion: Children with STSE in Connecticut who have Puerto Rican ethnicity or public insurance are at higher risk for moderate persistent asthma. This association did not hold for other degrees of asthma severity, including the more severe “severe persistent” subtype (for which there was insufficient power in our study), or for other indicators of SES. Given the unexpected absence of these further associations, further research is needed to illuminate the complex interrelationship between STSE, asthma severity, and SES. Our somewhat unexpected results were thought to reflect a complex picture in which race/ethnicity, environment, and development are all major factors for asthma severity, and also reiterated the ongoing question in asthma literature of whether different severities of asthma represent distinct disease entities.

Major Advisor

Jane Ungemack