Table 1.

Summary of studies of exposure to violence and asthma at the individual level, published since 2020

Type of exposure	References	Study design and study population	Main findings	Strength of the evidence
ETV and related distress	Gaietto, K. et al., 202212	Longitudinal 98 U.S. children aged 9–16 years treated with low-dose ICS in a 48-week randomized clinical trial (VDKA, 2016–2019), and 232 Puerto Rican youth aged 9–20 years resided in Puerto Rico followed by 5.4 years (2009–2010 and 2014–2017)	• 1-point increment in CCDS score was associated with 3.27% decrease in FEV1 %predicted and 2.65% decrease in FVC %predicted in the VDKA cohort • 1-point increment of CCDS score was associated with 0.30 points lower overall PAQLQ score in the VDKA cohort • 1-point increment in CCDS score was associated with 3.50% decrease in FEV1 %predicted and 2.23% decrease in FVC %predicted in the Puerto Rican replication cohort	• Moderate to high
ETV and related distress	Gaietto, K. et al., 202314	Cross-sectional and longitudinal 892 Puerto Rican children and youth aged 6–20 years resided in Puerto Rico, 2009–2010 and 2014–2017	• 742 and 150 participants had high and low Th2 immunity*, respectively • In the cross-sectional analyses, 1-point increment in ETV or CCDS score was associated with 1.13−1.54 times increased odds of asthma in participants with high Th2 immunity • In the longitudinal analyses, a persistently high ETV score was associated with persistent or new-onset asthma in youth with high Th2 immunity (OR= 2.83, 95% CI= 1.10−7.29)	• Moderate to high
Child maltreatment	Ospina, M.B. et al., 202131	Cross-sectional 1,207 Canadian adults living in Alberta, 2013	• Experiencing sexual abuse during childhood was associated with asthma in adulthood (OR=3.23, 95% CI=1.89–5.23) • Childhood verbal or physical abuse, or witnessing violence against mothers was associated with asthma in adulthood (95% CI=1.17–3.38)	• Weak to moderate
Child maltreatment	Han, Y.Y. et al., 202233	Cross-sectional 81,105 British adults aged 40–69 years from the U.K. Biobank, 2006–2010	• In women, any CM (OR=1.24, 95% CI=1.15–1.33) and sexual abuse (OR=1,29, 95% CI=1.16–1.43) were associated with current physician-diagnosed asthma • In men, any CM was associated with current physician-diagnosed asthma (OR=1.19, 95% CI=1.09–1.29) • In all participants, lifetime generalized anxiety disorder and lifetime major depressive disorder explained 21.8% and 32.5%, respectively, of the CM–current asthma association.	• Moderate
Child maltreatment	Kascakova, N. et al., 202230	Cross-sectional, population-based survey (national representative) 1,800 Czech adults aged 15–88 years and 1,018 Slovak adults age 18–85 years, 2016	• Any type of abuse or neglect was associated with 1.5- to 6.6 times increased odds of asthma in all participants • A dose-response relationship was reported, with participants who reported ≥ 3 types of maltreatment having the highest odds of asthma	• Weak to moderate
Child maltreatment	Han, Y.Y. et al., 202335	Cross-sectional 87,891 British adults aged 40–69 years from the U.K. Biobank, 2006–2010	• In women, exposure to ≥ 2 types of CM was associated with 1.26 (95% CI=1.13–1.41) to 1.62 (95% CI=1.44–1.83) times increased odds of current physician-diagnosed asthma after adjusting for adverse events during adulthood • In men, exposure to ≥ 2 types of CM was associated with 1.24 (95% CI=1.07–1.43) to 1.53 (95% CI=1.28–1.84) times increased odds of current physician-diagnosed asthma, after adjusting for adverse events during adulthood. • Similar findings were obtained in analyses stratified by smoking status or peripheral blood eosinophil count	• Moderate
Child maltreatment	Moog N.K. et al., 202325	Meta-analysis of longitudinal data from birth cohorts 4,337 mother-child dyads from 21 cohorts from the ECHO program,1999–2016	• Maternal exposure to CM was associated with asthma in their offspring (OR=1.54, 95% CI=1.34–1.77) • There was a dose-response relationship between the number of types of CM reported the mothers and risk of asthma in their offspring. • The association between maternal CM and asthma in offspring did not differ by child sex	• Moderate
Sexual violence (Rape)	Hancox, R.J. et al., 202041	Longitudinal population-based study 1,037 adults aged 38 years (born in 1972 or 1973), New Zealand	• In women, forced intercourse was associated with asthma (OR=4.47, 95% CI=2.22–8.99), wheeze (OR=2.19, 95% CI=1.23–3.90), and dysfunctional breathing (OR=2.71, 95% CI=1.47–5.01) • In men, forced intercourse was associated with increased dysfunctional breathing only (OR=8.05, 95% CI =2.53–25.70)	• Moderate
Bullying	Curry, C. W. et al., 202144	Cross-sectional, population-based survey 21,789 US youth in grades 9 to 12 in both public and private schools from the Youth Risk Behavior Survey, 2009–2017	• In female students, victimization from bullying (OR=1.54, 95% CI=1.23–1.92) and cyberbullying (OR=1.39, 95% CI=1.10–1.76) was associated with non-remitting asthma • In male students, victimization from bullying was associated with non-remitting asthma (OR=1.39, 95% CI=1.03–1.62).	• Weak to moderate
Bullying	Joseph, S.P. et al., 202245	Cross-sectional, population-based survey 19,766 U.S. children and adolescents aged 6–17 years from the National Survey of Children’s Health, 2018	• Experiencing bullying 1 to 2 times per year was associated with asthma (OR=1.28, 95% CI=1.06–1.55) • Being bullied at least 4 times per month was associated with asthma (OR=1.59, 95% CI=1.22–2.09)	• Weak to moderate

CM=child maltreatment, CCDS= Checklist of Children’s Distress Symptoms, CI=confidence interval; ECHO= Environmental influences on Child Health Outcomes, ETV=exposure to violence, FEV₁= forced expiratory volume in 1 second, FVC= forced vital capacity, ICS=inhaled corticosteroids, OR=odds ratio; PAQLQ= Pediatric Asthma Quality of Life Questionnaire, VDKA= Vitamin D Kids Asthma Study

^*High Th2‐immunity was defined as ≥1 positive allergen specific IgE and/or a total IgE ≥ 100 IU/mL and/or an eosinophil count ≥ 150 cells/μL

Sex-specific associations are shown when reported.