All ETDs from UAB

Advisory Committee Chair

Emily B Levitan

Advisory Committee Members

Gerald McGwin

Suzanne Perumean-Chaney

Teneasha Washington

Document Type


Date of Award


Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health


Sickle cell disease (SCD) is an inherited red blood cell disorder plagued by increased morbidity and premature mortality. Asthma disproportionally affects individuals with SCD and is strongly associated with an increased incidence of pain, acute lung complications and death among this high-risk population. Psychological stress is a well-established contributor and trigger for asthma development and exacerbations. Adverse Childhood Experiences (ACEs) are defined as traumatic experiences occurring before 18 years of age. ACEs occur at the individual, familial (Original-ACEs) and community level (Expanded-ACEs) and can accumulate with time. Chronic exposure to ACEs leads to toxic stress, widespread inflammation and risk for chronic disease development. Several studies have demonstrated a link between ACEs and asthma. The primary objective for this research was to test the hypothesis that, among children and adolescents with SCD, the prevalence of asthma will be higher among subjects that exposed to ACEs compared to subjects that have not been exposed to ACEs. Employing a cross-sectional study design, 75 children and adolescents with SCD were screened for ACEs using the Center for Youth Wellness Child and Teen ACE Questionnaires. They were categorized as having versus not having asthma through an electronic medical record extraction. Prevalence ratios were calculated to determine the risk for asthma among the exposed and non-exposed groups. iii The findings from this research demonstrated that children and adolescents with SCD exposed to Original-ACEs are 1.7 times more likely to have asthma compared to those that have not been exposed to ACEs (95% Confidence Interval [CI]: 1.2, 2.4). Children and adolescents with SCD and exposures to Expanded-ACEs (individual, familial and community-level combined) were 1.6 times more likely to have asthma, compared to subjects with no ACE exposures (95% CI: 1.1, 2.3). The findings from this research support the hypothesis that children and adolescents with SCD exposed to ACEs will have a higher prevalence of asthma compared to non-exposed subjects. This study lays the foundation for future longitudinal studies aimed to validate these findings, as well as interventional studies aimed to improve SCD-asthma health outcomes through ACE-protective mechanisms.

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