Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Dr. May G. Kennedy


Introduction: Work-related asthma (WRA) is thought to be the most common occupational lung disease in the U.S., but there is no standard case definition of WRA. Most states, including Virginia, do not require WRA diagnoses to be reported to health departments. At present, there is too little epidemiological data on WRA in Virginia to direct public health planning efforts. Objectives: The first objective of this study was to estimate potential exposure to workplace asthma triggers in each of Virginia's 35 health districts. The second objective was to examine associations at the health district level between workplace asthma triggers, other asthma risk factors, and asthma prevalence in Virginia. The third objective was to identify the specific health districts in which workers face the highest risk of WRA. Methods: This ecological study required merging three datasets. Information on weight, age, race/ethnicity, income, gender, and histories of asthma diagnosis and smoking was obtained from the Behavioral Risk Factor Surveillance System (BRFSS) and aggregated at the health district level. Information from the Virginia Employment Commission on the location, industry, and number of employees of each business in the state was combined with data on the asthma triggers found nationwide in specific industries to calculate estimates of potential exposure to WRA triggers in each health district. Descriptive, correlational and multiple regression analyses were conducted, and health districts were sorted by asthma prevalence, or number of workplace triggers, or trigger-based multivariate models of WRA risk.Results: On average, there are 50,104 employees potentially exposed to five or more asthma triggers in workplaces per health district. The number of ever-diagnosed adult asthmatics was highly correlated with the number of workplace asthma triggers in a health district, as well as with all demographic and behavioral risk factors. A linear regression model including number of workplace triggers, number of obese adults, and number of adults with incomes below 200% of poverty accounted for 84% of the variance in health district asthma prevalence. There was little overlap (2 health districts) between the set of highest-risk health districts identified by this model and the set identified by a sort on asthma prevalence alone. Conclusion: The findings of this exploratory ecological analysis suggest that the number of asthma cases in a health district may be an insufficient indicator of health district risk of WRA. Additional WRA surveillance and epidemiological research on WRA may be warranted in the health districts shown in this study to be at highest risk of the disease.


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Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Epidemiology Commons