{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:20Z","timestamp":1787028920379,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/objectives: The association between adverse childhood experiences (ACEs) and asthma severity among United States (US) adults with asthma has not been well documented. In addition, whether gender differences exist in this association has been underexplored. We aimed to examine the prevalence of asthma severity in the US adult population with asthma and investigate the association between ACEs and asthma severity by using data from non-institutionalized US adults with asthma. Methods: This cross-sectional study used data from the Adult 2019 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-Back Survey (ACBS), a survey of US adults aged 18 years or older in 31 US states and Puerto Rico. A total of 22934 adults with asthma participated in 2019 and 2020 ACBS. The 11 BRFSS ACE variables encompassing abuse and household dysfunction were used as ACE measures. ACE measures were summed up as cumulative ACE scores (continuous) and categorized (zero, one ACE, two ACEs, \u2265 three ACEs). Asthma severity was categorized as intermittent or persistent. Weighted logistic regression models were used to assess associations of the cumulative ACE score, categorical ACE measures, and the 11 individual ACE responses with asthma severity controlling confounders. Gender differences were explored by stratifying by gender. Results: The prevalence of persistent asthma among US adults with asthma was 45.3%. The mean cumulative ACE score in adults with intermittent vs. persistent asthma was (2.43 vs. 2.70, p-value &lt; 0.05). About 22% of adults with asthma had no ACEs, 19% had one ACE, 14% had two ACEs, and 45% had three or more ACEs. A one-unit increase in ACEs score was associated with a 5.4% increase in the odds of persistent asthma (adjusted odds ratio, aOR = 1.054 (95% confidence interval, CI = 1.01\u20131.10). Experiencing \u2265 three ACEs compared to no ACEs was associated with 31% increased odds of persistent asthma (aOR = 1.31, 95% CI = 1.01\u20131.70). Individual ACE items significantly associated with persistent asthma include parent\/adult ever touched you sexually (aOR = 1.33, 95% CI = 1.03\u20131.74), adult tried to make you touch them (aOR = 1.34, 95% CI = 1.01\u20131.79), any adult forced you to have sex (aOR = 1.44, 95% CI = 1.04\u20131.20), parental separation\/divorce (aOR = 1.31, 95% CI = 1.05\u20131.63), and household alcohol abuse (aOR = 1.24, 95% CI = 1.01\u20131.53). In women, experiencing one ACE and \u2265 three ACEs (compared to no ACEs) was associated with 51% and 60% increased odds of persistent asthma, respectively (aOR = 1.51, 95% CI = 1.02\u20132.23; aOR = 1.60, 95% CI = 1.12\u20132.27). No significant association was observed between ACEs and asthma severity in men; however, experiencing household physical violence (compared to no household physical violence) was associated with persistent asthma in men (aOR = 1.69, 95% CI = 1.18\u20132.42). Conclusions: In this cross-sectional study of US adults with asthma, exposure to ACEs was associated with higher odds of asthma overall and in women. These findings highlight the importance of preventive strategies and early interventions to reduce ACEs, potentially mitigating asthma\u2019s severity in adulthood.<\/jats:p>","DOI":"10.3390\/medsci12040063","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T11:34:11Z","timestamp":1731324851000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Adverse Childhood Experiences on Asthma Severity in US Adults"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9958-8478","authenticated-orcid":false,"given":"Chukwuemeka E.","family":"Ogbu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Cape Fear Valley Health, Fayetteville, NC 28304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7113-2631","authenticated-orcid":false,"given":"Ioannis","family":"Stouras","sequence":"additional","affiliation":[{"name":"Department of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3662-8184","authenticated-orcid":false,"given":"Chisa O.","family":"Oparanma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kharkiv National Medical University, 61022 Kharkiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella C.","family":"Ogbu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cape Fear Valley Health, Fayetteville, NC 28304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinazor","family":"Umerah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cape Fear Valley Health, Fayetteville, NC 28304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dharmage, S.C., Perret, J.L., and Custovic, A. (2019). Epidemiology of Asthma in Children and Adults. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00246"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/978-1-4614-8603-9_2","article-title":"Epidemiology of asthma: Prevalence and burden of disease","volume":"795","author":"Croisant","year":"2014","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/S0140-6736(17)33311-1","article-title":"Asthma","volume":"391","author":"Papi","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaci.2019.05.031","article-title":"Phenotypes and endotypes of adult asthma: Moving toward precision medicine","volume":"144","author":"Kaur","year":"2019","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.amepre.2015.12.012","article-title":"Asthma-Related School Absenteeism, Morbidity, and Modifiable Factors","volume":"51","author":"Hsu","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1080\/02770903.2017.1350972","article-title":"The national burden of poorly controlled asthma, school absence, and parental work loss among school-aged children in the United States","volume":"55","author":"Sullivan","year":"2018","journal-title":"J. Asthma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1183\/09031936.04.00116903","article-title":"Smoking and asthma in adults","volume":"24","author":"Piipari","year":"2004","journal-title":"Eur. Respir. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/S0140-6736(14)60617-6","article-title":"Outdoor air pollution and asthma","volume":"383","author":"Guarnieri","year":"2014","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1038\/ng.3985","article-title":"Shared genetic origin of asthma, hay fever, and eczema elucidates allergic disease biology","volume":"49","author":"Ferreira","year":"2017","journal-title":"Nat. Genet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5714","DOI":"10.1038\/s41467-019-13698-x","article-title":"The upper-airway microbiota and loss of asthma control among asthmatic children","volume":"10","author":"Zhou","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00281-020-00785-1","article-title":"Asthma epidemiology and risk factors","volume":"42","author":"Stern","year":"2020","journal-title":"Semin. Immunopathol."},{"key":"ref_12","unstructured":"Sacks, V., and Murphey, D. (2024, May 23). The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity. Available online: https:\/\/www.childtrends.org\/publications\/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/acps.12969","article-title":"The relationship between childhood adversities and dissociation in severe mental illness: A meta-analytic review","volume":"138","author":"Rafiq","year":"2018","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study","volume":"14","author":"Felitti","year":"1998","journal-title":"Am. J. Prev. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.amepre.2014.09.006","article-title":"Childhood adversity and adult chronic disease: An update from ten states and the District of Columbia, 2010","volume":"48","author":"Gilbert","year":"2015","journal-title":"Am. J. Prev. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1080\/02770903.2021.1910296","article-title":"Adverse childhood experiences and risk factors associated with asthma among children in the United States: The intersection of sex and race\/ethnicity","volume":"59","author":"Panisch","year":"2022","journal-title":"J. Asthma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"110388","DOI":"10.1016\/j.jpsychores.2021.110388","article-title":"Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators","volume":"143","author":"Suominen","year":"2021","journal-title":"J. Psychosom. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1720336","DOI":"10.1080\/20008198.2020.1720336","article-title":"Adverse childhood experiences and chronic lung diseases in adulthood: A systematic review and meta-analysis","volume":"11","author":"Lopes","year":"2020","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.acap.2021.04.021","article-title":"Adverse Childhood Experiences and Association With Pediatric Asthma Severity in the 2016\u20132017 National Survey of Children\u2019s Health","volume":"21","author":"Ross","year":"2021","journal-title":"Acad. Pediatr."},{"key":"ref_20","unstructured":"Centers for Disease Control and Prevention (2023, May 10). BRFSS Asthma Call-Back Survey (ACBS), Available online: https:\/\/www.cdc.gov\/brfss\/acbs\/2019_documentation.html."},{"key":"ref_21","unstructured":"CDC Behavioral Risk Factor Surveillance System (2023, May 23). 2019 Summary Data Quality Report, Available online: https:\/\/www.cdc.gov\/brfss\/annual_data\/2019\/pdf\/2019-sdqr-508.pdf."},{"key":"ref_22","unstructured":"CDC Behavioral Risk Factor Surveillance System (2023, May 23). 2020 Summary Data Quality Report, Available online: https:\/\/www.cdc.gov\/brfss\/annual_data\/2020\/pdf\/2020-sdqr-508.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"610","DOI":"10.3109\/02770903.2014.892966","article-title":"Assessing asthma severity among children and adults with current asthma","volume":"51","author":"Zahran","year":"2014","journal-title":"J. Asthma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1080\/02770903.2017.1290105","article-title":"Long-term control medication use and asthma control status among children and adults with asthma","volume":"54","author":"Zahran","year":"2017","journal-title":"J. Asthma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"318","DOI":"10.3109\/02770903.2014.956894","article-title":"Assessing asthma control and associated risk factors among persons with current asthma\u2014Findings from the child and adult Asthma Call-back Survey","volume":"52","author":"Zahran","year":"2015","journal-title":"J. Asthma"},{"key":"ref_26","unstructured":"US Department of Health and Human Services, National Institutes of Health (NIH), National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program (NAEPP) (2024, May 23). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK7232\/pdf\/Bookshelf_NBK7232.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1037\/a0037723","article-title":"Examination of the Factorial Structure of Adverse Childhood Experiences and Recommendations for Three Subscale Scores","volume":"4","author":"Ford","year":"2014","journal-title":"Psychol. Violence"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"LaNoue, M.D., George, B.J., Helitzer, D.L., and Keith, S.W. (2020). Contrasting cumulative risk and multiple individual risk models of the relationship between Adverse Childhood Experiences (ACEs) and adult health outcomes. BMC Med. Res. Methodol., 20.","DOI":"10.1186\/s12874-020-01120-w"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1370\/afm.1363","article-title":"Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide","volume":"10","author":"Huntley","year":"2012","journal-title":"Ann. Fam. Med."},{"key":"ref_30","unstructured":"Schreiber-Gregory, D.N., and Jackson, H.M. (2017, January 2\u20135). Multicollinearity: What is it, why should we care, and how can it be controlled?. Proceedings of the SAS Global Forum 2017 Conference, Orlando, FL, USA. Available online: https:\/\/support.sas.com\/resources\/papers\/proceedings17\/1404-2017.pdf."},{"key":"ref_31","first-page":"99","article-title":"Association of Adverse Childhood Experiences with Life Course Health and Development","volume":"79","author":"Austin","year":"2018","journal-title":"N. C. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.amepre.2015.07.022","article-title":"Associations between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood","volume":"50","author":"Campbell","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1542\/peds.2011-2663","article-title":"The lifelong effects of early childhood adversity and toxic stress","volume":"129","author":"Shonkoff","year":"2012","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.physbeh.2011.08.019","article-title":"Adverse childhood experiences, allostasis, allostatic load, and age-related disease","volume":"106","author":"Danese","year":"2012","journal-title":"Physiol. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Berens, A.E., Jensen, S.K.G., and Nelson, C.A. (2017). Biological embedding of childhood adversity: From physiological mechanisms to clinical implications. BMC Med., 15.","DOI":"10.1186\/s12916-017-0895-4"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1164\/rccm.200607-898OC","article-title":"Early-life psychological stress exacerbates adult mouse asthma via the hypothalamus-pituitary-adrenal axis","volume":"175","author":"Chida","year":"2007","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5496","DOI":"10.1073\/pnas.0506312103","article-title":"Life stress and diminished expression of genes encoding glucocorticoid receptor and beta2-adrenergic receptor in children with asthma","volume":"103","author":"Miller","year":"2006","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1038\/mp.2010.5","article-title":"Biological embedding of stress through inflammation processes in childhood","volume":"16","author":"Danese","year":"2011","journal-title":"Mol. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Chatterjee, N. (2018). Stress Runs Deep and Long: Identification of Molecular Biomarkers of Childhood Stress in Adults. BioEssays, 40.","DOI":"10.1002\/bies.201800126"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1183\/09031936.00046213","article-title":"Telomere length in circulating leukocytes is associated with lung function and disease","volume":"43","author":"Albrecht","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"767","DOI":"10.14423\/SMJ.0000000000000567","article-title":"Association Between Maternal-Perceived Psychological Stress and Fetal Telomere Length","volume":"109","author":"Salihu","year":"2016","journal-title":"South. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1017\/S2040174422000083","article-title":"Adulthood asthma as a consequence of childhood adversity: A systematic review of epigenetically affected genes","volume":"13","author":"Saygideger","year":"2022","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1387\/ijdb.140077mb","article-title":"Epigenetics and imprinting in human disease","volume":"58","author":"Kalish","year":"2014","journal-title":"Int. J. Dev. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"101925","DOI":"10.1016\/j.jcrimjus.2022.101925","article-title":"Gender differences in early adverse childhood experiences and youth psychological distress","volume":"83","author":"Jones","year":"2022","journal-title":"J. Crim. Justice"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"108056","DOI":"10.1016\/j.jsat.2020.108056","article-title":"Something to despair: Gender differences in adverse childhood experiences among rural patients","volume":"116","author":"Winstanley","year":"2020","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1708618","DOI":"10.1080\/20008198.2019.1708618","article-title":"Females have more complex patterns of childhood adversity: Implications for mental, social, and emotional outcomes in adulthood","volume":"11","author":"Perera","year":"2020","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_47","first-page":"1","article-title":"Screening for adverse childhood experiences (ACEs): Cautions and suggestions","volume":"72","author":"Finkelhor","year":"2017","journal-title":"Child Abus. Negl."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"137","DOI":"10.3109\/08039488.2013.786133","article-title":"Can social support alleviate inflammation associated with childhood adversities?","volume":"68","author":"Runsten","year":"2014","journal-title":"Nord. J. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1164\/rccm.2107057","article-title":"The burden of asthma in the United States: Level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines","volume":"166","author":"Fuhlbrigge","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.anai.2011.12.017","article-title":"The CHOICE survey: High rates of persistent and uncontrolled asthma in the United States","volume":"108","author":"Colice","year":"2012","journal-title":"Ann. Allergy Asthma Immunol."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/12\/4\/63\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:30:13Z","timestamp":1760113813000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/12\/4\/63"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,11]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["medsci12040063"],"URL":"https:\/\/doi.org\/10.3390\/medsci12040063","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,11]]}}}