PURPOSE OF THE STUDY.
To examine the relationship between single and cumulative adverse childhood experiences (ACEs), a measurement of household dysfunction, on parent report of lifetime asthma in children.
There were 92 427 children aged 0 to 17 years of age in households sampled by the National Survey of Children’s Health, a cross-sectional telephone survey conducted in 2011–2012 by the Centers for Disease Control and Prevention.
This was a random dialing survey of households, evaluating 1 child per household who was randomly selected. The survey was conducted in multiple languages. Asthma prevalence was measured using parent or guardian response to the question, “Has a doctor or other health care provider every told you that [sample child] had asthma?” Data were collected on 6 ACEs related to parental divorce, death, jail time, mental illness, alcohol or drug abuse, or physical abuse (not to the child); as well as socioeconomic, demographic data, and asthma risk factors. Adjustments were made for gender, age, race or ethnicity, poverty level, prematurity, and smoking exposure, all of which were independently associated with a lifetime risk of asthma.
Increasing exposure to ACEs was associated with a higher percentage of children with asthma, compared with the overall study population and increasing odds of reporting lifetime asthma. Of children with exposure to at least 5 ACEs, lifetime asthma diagnosis was 25.4% compared with 12.3% in children with 0 ACEs, with the odds of reporting lifetime asthma 1.61 with 5 ACEs. Children no older than 5 years and exposed to 3 ACEs had 4.94 times increased odds of reporting asthma, odds declined in older children but were 2.36 times with 5 ACEs compared with 0 ACEs. Odds were highest in Hispanic children, 4.46 times in those exposed to 4 ACEs compared with 1.19 in non-Hispanic white children.
This is the first study to show an association between home ACEs and childhood lifetime asthma. These findings underscore the need for close monitoring of these particularly “high-risk” children, especially those of Hispanic ethnicity. The identification of such childhood stressors may help target interventions to perhaps prevent the development of asthma.
This study adds to the increasing level of evidence on ACEs and their effect on long-term health. This and other studies suggest population and individual intervention strategies that could potentially prevent the development of disease.
- Copyright © 2015 by the American Academy of Pediatrics