Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
5-2026
Committee Chair or Co-Chairs
Megan Quinn
Committee Members
Bill Brooks, Bethesda O'Connell
Abstract
Background: Little is known about the relationship between positive childhood experiences (PCEs), adverse childhood experiences (ACEs), and asthma throughout the lifespan in Tennessee (Hero et al., 2025; Huang et al., 2023). While the association between higher ACEs and higher odds of developing asthma are established in the literature, PCEs and asthma remain understudied, particularly among Tennesseans (Sandberg et al., 2000; Valrie et al., 2024). Asthma is the second most common health condition in Tennessee K-12 schools, and when left uncontrolled, can persist into adulthood (Tennessee Department of Education, 2024b; Koefoed et al., 2022). This dissertation examines PCEs, ACEs, and asthma across individual and community levels in Tennessee.
Methods: A scoping review assessed PCEs and physiological health outcomes across the lifespan. The second manuscript used 2023 Tennessee BRFSS data to evaluate the association between PCEs and the likelihood of ever being diagnosed with asthma, while controlling for ACEs and sociodemographic factors. The third manuscript conducted an ecological school district-level multivariable regression (n=122) examining school system support factors, adversity, and sociodemographic characteristics associated with asthma detection in Tennessee to inform policies and practices.
Results: The scoping review included eight studies: five observed interaction between PCEs and ACEs. The empirical analysis found higher PCEs were associated with lower odds of asthma compared with low PCEs (aOR = 0.62; 95% CI: 0.42-0.93; p = 0.019). The association remained but not significant after ACE adjustment. Higher ACE exposure demonstrated a dose-response relationship with higher asthma odds, including a two-fold increase among those with 4+ ACEs (aOR=2.2; 95% CI: 1.58-3.08; p < .001). The policy and practice analysis observed school districts with unfavorable or no nurse staffing had lower odds of high asthma detection compared with school districts with favorable nurse staffing (aOR=0.37; 95% CI: 0.15-0.89; p = 0.026).
Implications: Findings suggest that PCEs and ACEs are independently associated with asthma and simultaneously coexist; while school nurse staffing emerged as a key biopsychosocial support associated with asthma detection among school districts. Policy and processes are recommended that promote PCEs while addressing ACEs.
Document Type
Dissertation - embargo
Recommended Citation
Mooney, Hopelyn A., "Breathing Room: Associations Between Positive Childhood Experiences, Adverse Childhood Experiences, and Asthma throughout the Lifespan in Tennessee" (2026). Electronic Theses and Dissertations. Paper 4661. https://dc.etsu.edu/etd/4661
Copyright
Copyright by the authors.
Included in
Community Health and Preventive Medicine Commons, Epidemiology Commons, Maternal and Child Health Commons
