Date of Award

Spring 2019

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Mujde Erten-Unal

Committee Member

Jim Blando

Committee Member

Olaniyi Olayinka


The occurrence of a natural disaster event such as a hurricane may further hinder the asthma management of asthmatic individuals. Unmanaged asthma has led to increased work absenteeism, preventable emergency department visits, costly hospitalizations and possibly death in severe cases. To improve asthma management in asthmatic adults in New Jersey (NJ) following a natural disaster event, this study examined whether predisposing, enabling and need factors are predictors for asthma exacerbation and asthma-related health care utilization in New Jersey. A retrospective secondary analysis of New Jersey Behavioral Risk Factor Surveillance System (NJBRFSS) data and New Jersey Asthma Call Back Survey (NJACBS) data was conducted on 2011 and 2013 data, which correspond to the pre and post Hurricane Sandy time frame. The Behavioral Model for Vulnerable Populations was used to guide the selection of the disaster-related predisposing, enabling and need risk factors in the study. The data was further stratified into two county comparison groups using the Sandy Community Hardship Index and the Federal Emergency Management Agency (FEMA) Flooding Map to examine the differences in predictors for asthma exacerbation or attacks and asthma-related health care utilization in high impact and low impact county groups. Descriptive statistics, Univariate analyses and Binomial Logistic Regressions were ran using a p-value of 0.05 to determine if there were any statistically significant relationships between the identified risk factors from the conceptual framework and the outcome variables. The study found that at the state level, there are different significant predictors before and after Hurricane Sandy. Perceived cost barrier to medication, being given an asthma management plan and seeing or smelling mold were significant predictors at the state level. Seeing or smelling mold was the only significant predictor for the high impact county group. Overall, this study provided a new conceptual framework and supporting evidence regarding determinants related to asthma exacerbations and asthma-related health care utilization after a natural disaster event in asthmatic adults in NJ. The results of this study can inform public health practice in New Jersey and help improve health education interventions and health policies directed at asthmatic adults after a natural disaster event.