Date of Award


Document Type

Campus Access Thesis


Epidemiology and Biostatistics



First Advisor

Wilfried Karmaus


Increased asthma worldwide demands efforts in prevention which are only possible if risk factors are properly identified and understood. Studies have linked maternal smoking and breastfeeding with asthma. Additionally, there has been an observed phenomenon during adolescence where asthma prevalence shifts from being higher in boys to being higher in girls. Puberty is a period of developmental transition and therefore a target for prevention. However, puberty is not an isolated event as early life factors influence its onset and duration. We examined the network of causal pathways between prenatal, childhood, and pubertal factors with adult force vital capacity (FVC) in the Isle of Wight Birth Cohort Study (n=1,456). Path analysis was used investigating possible associations between gestational maternal smoking, breast feeding, birth weight, early weight gain, age of menarche and breast development (for females only), age of growth spurt (for males only), and adult height and FVC. In males there was a pathway linking maternal smoking to breastfeeding to infant weight gain to age of growth spurt which was finally associated with FVC. In addition, maternal smoking was significantly associated with FVC. In females there was a significant association between breastfeeding and FVC. In females a pathway was observed connecting maternal smoking, breastfeeding, infant weight gain, breast development, menarche, and FVC. These causal webs show how gestational maternal smoking and breastfeeding affect lung health via individual growth and puberty. This contributes to an understanding of asthma etiology and natural history that can be used in preventative public health practice.


© 2011, Mitra Yousefi