Date of Conferral

4-2-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Joseph Robare

Abstract

Hypovitaminosis D is a significant public health concern in the United States associated with inadequate sunlight exposure and insufficient dietary intake. Asthma is a chronic respiratory condition that progressively worsens over time. While asthma is typically managed through individual-level treatment approaches, population-level strategies such as vitamin D supplementation and food fortification policies have not been implemented. A five-tier Public Health Impact Pyramid theoretical foundation guided this nonexperimental quantitative cross-sectional study. Data from 2013-2014 and 2017-2018 NHANES (n = 1,456) was evaluated for relationships between vitamin D supplementation, duration of sunlight exposure, and food security index, with asthma, asthma exacerbation severity, and respiratory tract infections in individuals between 16 and 30 while controlling for race, household crowding index, and smoking. A complex sample binary logistic regression analyses indicated achieving vitamin D RDA was significantly associated with a decreased risk of asthma exacerbation severity (B = -25.604, SE = 1.087, t(13) = -23.556, p < 0.001, OR =2.676E-12, 95% CI [1.416E-12, 5.057E-12]) and FSI was significantly associated with RTIs (p < 0.001). However, the nature of the relationship between FSI and RTIs could not be established using the current model. Results from this study include evidence that food fortification policies involving staple food items can change environmental contexts and decrease barriers including social determinants of health associated with hypovitaminosis D, resulting in positive social change among young adults to improve long-term respiratory health outcomes.

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