Moderating Effects of Physical Activity on the Relationship between Adverse Childhood Experiences and Health-Related Quality of Life
Abstract
:1. Introduction
- (1)
- Do ACEs and the sub-domains (i.e., child abuse and household dysfunction) negatively influence HRQOL, physical health over time, and mental health over time, even when numerous covariates are controlled for?
- (2)
- Does the level of PA moderate the effect of ACEs and the sub-domains (i.e., child abuse and household dysfunction) on HRQOL, physical health over time, and mental health over time, even when numerous covariates are controlled for?
2. Materials and Methods
2.1. Study Sample
2.2. Measures
2.3. Data Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ACEs | Adverse childhood experiences |
BRFSS | Behavioral Risk Factor Surveillance System |
CDC | Center for Disease Control |
CDM | Covariate-dependent missingness |
HRQOL | Health-related quality of life |
MCAR | Missing is completely at random |
ML | Maximum likelihood |
PA | Physical activity |
SEM | Structural Equation Modeling |
References
- Chang, X.; Jiang, X.; Mkandarwire, T.; Shen, M. Associations between adverse childhood experiences and health outcomes in adults aged 18–59 years. PLoS ONE 2019, 14, e0211850. [Google Scholar] [CrossRef]
- Dube, S.R.; Felitti, V.J.; Dong, M.; Giles, W.H.; Anda, R.F. The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Prev. Med. 2003, 37, 268–277. [Google Scholar] [CrossRef] [Green Version]
- Lee, R.D.; Chen, J. Adverse childhood experiences, mental health, and excessive alcohol use: Examination of race/ethnicity and sex differences. Child Abus. Negl. 2017, 69, 40–48. [Google Scholar] [CrossRef] [Green Version]
- Palusci, V.J. Adverse childhood experiences and lifelong health. JAMA Pediatrics 2013, 167, 95–96. [Google Scholar] [CrossRef] [PubMed]
- Goldstein, E.; Topitzes, J.; Miller-Cribbs, J.; Brown, R.L. Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing. Pediatric Res. 2021, 89, 1861–1869. [Google Scholar] [CrossRef] [PubMed]
- Merrick, M.T.; Ford, D.C.; Ports, K.A.; Guinn, A.S. Prevalence of adverse childhood experiences from the 2011–2014 behavioral risk factor surveillance system in 23 states. JAMA Pediatrics 2018, 172, 1038–1044. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- CDC Violence Prevention. About the CDC-Kaiser ACE Study. Available online: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html (accessed on 10 December 2021).
- Giano, Z.; Wheeler, D.L.; Hubach, R.D. The frequencies and disparities of adverse childhood experiences in the US. BMC Public Health 2020, 20, 1327. [Google Scholar] [CrossRef]
- Sedlak, A.J.; Mettenburg, J.; Basena, M.; Peta, I.; McPherson, K.; Greene, A. Fourth National Incidence Study of Child Abuse and Neglect (NIS-4); US Department of Health and Human Services: Washington, DC, USA, 2010; Volume 9, pp. 1–147. [Google Scholar]
- Metzler, M.; Merrick, M.T.; Klevens, J.; Ports, K.A.; Ford, D.C. Adverse childhood experiences and life opportunities: Shifting the narrative. Child. Youth Serv. Rev. 2017, 72, 141–149. [Google Scholar] [CrossRef] [Green Version]
- Blodgett, C.; Lanigan, J.D. The association between adverse childhood experience (ACE) and school success in elementary school children. Sch. Psychol. Q. 2018, 33, 137–146. [Google Scholar] [CrossRef]
- Oh, D.L.; Jerman, P.; Marques, S.S.; Koita, K.; Boparai, S.K.P.; Harris, N.B.; Bucci, M. Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatrics 2018, 18, 83. [Google Scholar] [CrossRef]
- Hughes, K.; Lowey, H.; Quigg, Z.; Bellis, M.A. Relationships between adverse childhood experiences and adult mental well-being: Results from an English national household survey. BMC Public Health 2016, 16, 222. [Google Scholar] [CrossRef] [Green Version]
- Van Duin, L.; Bevaart, F.; Zijlmans, J.; Luijks, M.J.A.; Doreleijers, T.A.; Wierdsma, A.I.; Oldehinkel, A.J.; Marhe, R.; Popma, A. The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults. Eur. Child Adolesc. Psychiatry 2019, 28, 1065–1078. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Anda, R.F.; Brown, D.W.; Dube, S.R.; Bremner, J.D.; Felitti, V.J.; Giles, W.H. Adverse childhood experiences and chronic obstructive pulmonary disease in adults. Am. J. Prev. Med. 2008, 34, 396–403. [Google Scholar] [CrossRef]
- Brown, D.W.; Anda, R.F.; Tiemeier, H.; Felitti, V.J.; Edwards, V.J.; Croft, J.B.; Giles, W.H. Adverse childhood experiences and the risk of premature mortality. Am. J. Prev. Med. 2009, 37, 389–396. [Google Scholar] [CrossRef] [PubMed]
- Ford, E.S.; Anda, R.F.; Edwards, V.J.; Perry, G.S.; Zhao, G.; Li, C.; Croft, J.B. Adverse childhood experiences and smoking status in five states. Prev. Med. 2011, 53, 188–193. [Google Scholar] [CrossRef] [PubMed]
- Halfon, N.; Larson, K.; Son, J.; Lu, M.; Bethell, C. Income inequality and the differential effect of adverse childhood experiences in US children. Acad. Pediatrics 2017, 17, S70–S78. [Google Scholar] [CrossRef] [Green Version]
- Hughes, K.; Bellis, M.A.; Hardcastle, K.A.; Sethi, D.; Butchart, A.; Mikton, C.; Jones, L.; Dunne, M.P. The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. Lancet Public Health 2017, 2, e356–e366. [Google Scholar] [CrossRef] [Green Version]
- Danese, A.; Moffitt, T.E.; Harrington, H.; Milne, B.J.; Polanczyk, G.; Pariante, C.M.; Poulton, R.; Caspi, A. Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk markers. Arch. Pediatrics Adolesc. Med. 2009, 163, 1135–1143. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Salinas-Miranda, A.A.; Salemi, J.L.; King, L.M.; Baldwin, J.A.; Austin, D.A.; Scarborough, K.; Spooner, K.K.; Zoorob, R.J.; Salihu, H.M. Adverse childhood experiences and health-related quality of life in adulthood: Revelations from a community needs assessment. Health Qual. Life Outcomes 2015, 13, 123. [Google Scholar] [CrossRef] [Green Version]
- Downing, N.R.; Akinlotan, M.; Thornhill, C.W. The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life. Child Abus. Negl. 2021, 120, 105181. [Google Scholar] [CrossRef]
- Hussaini, K.S.; Powell, T.O.; Christensen, M.; Woodall, L. The impact of adverse childhood experiences (ACE) on health-related quality of life, mental health, and hospitalizations in Delaware. Del. J. Public Health 2016, 2, 54–57. [Google Scholar] [CrossRef]
- Moriarty, D.G.; Zack, M.M.; Kobau, R. The Centers for Disease Control and Prevention’s Healthy Days Measures–Population tracking of perceived physical and mental health over time. Health Qual. Life Outcomes 2003, 1, 37. [Google Scholar] [CrossRef] [Green Version]
- Bamm, E.L.; Rosenbaum, P.; Wilkins, S. Is Health Related Quality of Life of people living with chronic conditions related to patient satisfaction with care? Disabil. Rehabil. 2013, 35, 766–774. [Google Scholar] [CrossRef]
- Moon, I.; Frost, A.K.; Kim, M. The role of physical activity on psychological distress and health-related quality of life for people with comorbid mental illness and health conditions. Soc. Work Ment. Health 2020, 18, 410–428. [Google Scholar] [CrossRef]
- Slabaugh, S.L.; Shah, M.; Zack, M.; Happe, L.; Cordier, T.; Havens, E.; Davidson, E.; Miao, M.; Prewitt, T.; Jia, H. Leveraging health-related quality of life in population health management: The case for healthy days. Popul. Health Manag. 2017, 20, 13–22. [Google Scholar] [CrossRef] [PubMed]
- Felitti, V.J.; Anda, R.F.; Nordenberg, D.; Williamson, D.F.; Spitz, A.M.; Edwards, V.; Marks, J.S. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am. J. Prev. Med. 1998, 14, 245–258. [Google Scholar] [CrossRef]
- McNamee, L.; Mead, G.; MacGillivray, S.; Lawrie, S.M. Schizophrenia, poor physical health and physical activity: Evidence-based interventions are required to reduce major health inequalities. Br. J. Psychiatry 2013, 203, 239–241. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Oeland, A.-M.; Laessoe, U.; Olesen, A.V.; Munk-Jørgensen, P. Impact of exercise on patients with depression and anxiety. Nord. J. Psychiatry 2010, 64, 210–217. [Google Scholar] [CrossRef]
- Warburton, D.E.; Nicol, C.W.; Bredin, S.S. Health benefits of physical activity: The evidence. CMAJ 2006, 174, 801–809. [Google Scholar] [CrossRef] [Green Version]
- Perales, F.; Pozo-Cruz, J.D.; Pozo-Cruz, B.D. Impact of physical activity on psychological distress: A prospective analysis of an Australian national sample. Am. J. Public Health 2014, 104, e91–e97. [Google Scholar] [CrossRef]
- Van Berkel, J.; Proper, K.I.; van Dam, A.; Boot, C.R.; Bongers, P.M.; van der Beek, A.J. An exploratory study of associations of physical activity with mental health and work engagement. BMC Public Health 2013, 13, 558. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Easterlin, M.C.; Chung, P.J.; Leng, M.; Dudovitz, R. Association of team sports participation with long-term mental health outcomes among individuals exposed to adverse childhood experiences. JAMA Pediatrics 2019, 173, 681–688. [Google Scholar] [CrossRef]
- Boisgontier, M.P.; Orsholits, D.; von Arx, M.; Sieber, S.; Miller, M.W.; Courvoisier, D.; Iversen, M.D.; Cheval, B. Adverse childhood experiences, depressive symptoms, functional dependence, and physical activity: A moderated mediation model. J. Phys. Act. Health 2020, 17, 790–799. [Google Scholar] [CrossRef]
- Negriff, S. ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence. Soc. Sci. Med. 2020, 245, 112696. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention-Behavioral Risk Factor Surveillance System. Available online: http://www.cdc.gov/brfss/ (accessed on 10 December 2021).
- Nelson, D.E.; Holtzman, D.; Bolen, J.; Stanwyck, C.A.; Mack, K.A. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz. Praventivmed. 2001, 46, S3–S42. [Google Scholar] [PubMed]
- Centers for Disease Control and Prevention. Measuring Healthy Days: Population Assessment of Health-Related Quality of Life. 2000. Available online: https://www.cdc.gov/hrqol/pdfs/mhd.pdf (accessed on 10 December 2021).
- Yin, S.; Njai, R.; Barker, L.; Siegel, P.Z.; Liao, Y. Summarizing health-related quality of life (HRQOL): Development and testing of a one-factor model. Popul. Health Metr. 2016, 14, 22. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lambert, C.; Thacker, K.; Shamblin, A. The Prevalence of Adverse Childhood Experiences and their Association with Adult Health: 2018 Indiana Behavioral Risk Factor Surveillance System Survey. Indiana State Dep. Health 2020, 1–15. Available online: https://content.govdelivery.com/attachments/INSDH/2020/08/17/file_attachments/1519314/2018_Final_BRFSS_ACE_Report.pdf (accessed on 10 December 2021).
- Stabler, M.; Perveen, G. Adverse Childhood Experiences among Kansas Adults: 2014–2015 Kansas Behavioral Risk Factor Surveillance System. Kans. Dep. Health Environ. 2017, 1–23. Available online: https://www.kdhe.ks.gov/archive.aspx?amid=&type=&adid=981 (accessed on 3 January 2022).
- Abell, J.E.; Hootman, J.M.; Zack, M.M.; Moriarty, D.; Helmick, C.G. Physical activity and health related quality of life among people with arthritis. J. Epidemiol. Community Health 2005, 59, 380–385. [Google Scholar] [CrossRef] [Green Version]
- Kimsey, C.D.; Ham, S.A.; Macera, C.A.; Ainsworth, B.; Jones, D.A. Reliability of moderate and vigorous physical activity questions in the Behavioral Risk Factor Surveilance System (BRFSS). Med. Sci. Sports Exerc. 2003, 35, S114. [Google Scholar] [CrossRef]
- Yore, M.M.; Ham, S.A.; Ainsworth, B.E.; Kruger, J.; Reis, J.P.; Kohl, H.W., 3rd; Macera, C.A. Reliability and validity of the instrument used in BRFSS to assess physical activity. Med. Sci. Sports Exerc. 2007, 39, 1267–1274. [Google Scholar] [CrossRef]
- Ferrans, C.E.; Zerwic, J.J.; Wilbur, J.E.; Larson, J.L. Conceptual model of health-related quality of life. J. Nurs. Scholarsh. 2005, 37, 336–342. [Google Scholar] [CrossRef]
- Rizzo, V.M.; Kintner, E. The utility of the behavioral risk factor surveillance system (BRFSS) in testing quality of life theory: An evaluation using structural equation modeling. Qual. Life Res. 2013, 22, 987–995. [Google Scholar] [CrossRef]
- Lund, R.S.; Karlsen, T.-I.; Hofsø, D.; Fredheim, J.M.; Røislien, J.; Sandbu, R.; Hjelmesæth, J. Employment is associated with the health-related quality of life of morbidly obese persons. Obes. Surg. 2011, 21, 1704–1709. [Google Scholar] [CrossRef] [Green Version]
- Hartwell, M.L.; Khojasteh, J.; Wetherill, M.S.; Croff, J.M.; Wheeler, D. Using structural equation modeling to examine the influence of social, behavioral, and nutritional variables on health outcomes based on NHANES data: Addressing complex design, nonnormally distributed variables, and missing information. Curr. Dev. Nutr. 2019, 3, nzz010. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- StataCorp LP. Stata Statistical Software: Release 13; StataCorp LP: College Station, TX, USA, 2013. [Google Scholar]
- Kraemer, H.C.; Kiernan, M.; Essex, M.; Kupfer, D.J. How and why criteria defining moderators and mediators differ between the Baron; Kenny and MacArthur approaches. Health Psychol. 2008, 27, S101–S108. [Google Scholar] [CrossRef] [Green Version]
- Gatignon, H.; Vosgerau, J. Stochastic Moderated Regression: An Efficient Methodology for Estimating Parameters in Moderated Regression. 2006. Available online: https://www.insead.edu/sites/default/files/assets/faculty-personal-site/hubert-gatignon/documents/INSEAD%20WP-2006-17-MKT_Gatignon%20Vosgerau_Stochastic%20Moderated%20Regression%20.pdf (accessed on 11 December 2021).
- Preacher, K.J.; Rucker, D.D.; Hayes, A.F. Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivar. Behav. Res. 2007, 42, 185–227. [Google Scholar] [CrossRef]
- Winter, N. CORR_SVY: Stata Module to Compute Correlation Tables for Survey Data. Statistical Software Components from Boston College Department of Economics. 2001. Available online: https://econpapers.repec.org/software/bocbocode/s422701.htm (accessed on 11 December 2021).
- Acock, A.C. A Gentle Introduction to Stata, 3rd ed.; Stata Press: College Station, TX, USA, 2012. [Google Scholar]
- Li, C. Little’s test of missing completely at random. Stata J. 2013, 13, 795–809. [Google Scholar] [CrossRef] [Green Version]
- Acock, A.C. Discovering Structural Equation Modeling Using Stata; Revised Edition; Stata Press: College Station, TX, USA, 2013. [Google Scholar]
- Ullman, J.B. Structural equation modeling: Reviewing the basics and moving forward. J. Personal. Assess. 2006, 87, 35–50. [Google Scholar] [CrossRef] [PubMed]
- Chanlongbutra, A.; Singh, G.K.; Mueller, C.D. Adverse childhood experiences, health-related quality of life, and chronic disease risks in rural areas of the United States. J. Environ. Public Health 2018, 2018, 1–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Corso, P.S.; Edwards, V.J.; Fang, X.; Mercy, J.A. Health-related quality of life among adults who experienced maltreatment during childhood. Am. J. Public Health 2008, 98, 1094–1100. [Google Scholar] [CrossRef]
- Bize, R.; Johnson, J.A.; Plotnikoff, R.C. Physical activity level and health-related quality of life in the general adult population: A systematic review. Prev. Med. 2007, 45, 401–415. [Google Scholar] [CrossRef]
- Halaweh, H.; Willen, C.; Grimby-Ekman, A.; Svantesson, U. Physical activity and health-related quality of life among community dwelling elderly. J. Clin. Med. Res. 2015, 7, 845–852. [Google Scholar] [CrossRef] [Green Version]
- Xu, H.; Tang, L.; Hu, Z.; Gao, F.; Yang, Y.; Qin, L.; Luo, B.A. Association between physical activity and health-related quality of life in elderly individuals with pre-diabetes in rural Hunan Province, China: A cross-sectional study. BMJ Open 2018, 8, e019836. [Google Scholar] [CrossRef]
- Villalobos, F.; Vinuesa, A.; Pedret, R.; Basora, T.; Basora, J.; Arija, V. Physical activity and health-related quality of life in adults: The “Pas a Pas” community intervention programme. Ment. Health Phys. Act. 2019, 17, 100301. [Google Scholar] [CrossRef]
- Arija, V.; Villalobos, F.; Pedret, R.; Vinuesa, A.; Jovani, D.; Pascual, G.; Basora, J. Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: Randomized clinical trial. Health Qual. Life Outcomes 2018, 16, 184. [Google Scholar] [CrossRef]
- Deuster, P.A.; Silverman, M.N. Physical fitness: A pathway to health and resilience. US Army Med. Dep. J. 2013, 24–35. [Google Scholar]
- Aas, M.; Ueland, T.; Mørch, R.H.; Laskemoen, J.F.; Lunding, S.H.; Reponen, E.J.; Cattaneo, A.; Agartz, I.; Melle, I.; Steen, N.E.; et al. Physical activity and childhood trauma experiences in patients with schizophrenia or bipolar disorders. World J. Biol. Psychiatry 2021, 22, 637–645. [Google Scholar] [CrossRef]
- Oppizzi, L.M.; Umberger, R. The effect of physical activity on PTSD. Issues Ment. Health Nurs. 2018, 39, 179–187. [Google Scholar] [CrossRef] [PubMed]
- Hegberg, N.J.; Hayes, J.P.; Hayes, S.M. Exercise intervention in PTSD: A narrative review and rationale for implementation. Front. Psychiatry 2019, 10, 133. [Google Scholar] [CrossRef] [PubMed]
- Vancampfort, D.; Stubbs, B.; Richards, J.; Ward, P.B.; Firth, J.; Schuch, F.B.; Rosenbaum, S. Physical fitness in people with posttraumatic stress disorder: A systematic review. Disabil. Rehabil. 2017, 39, 2461–2467. [Google Scholar] [CrossRef]
- Josyula, L.K.; Lyle, R.M. Barriers in the implementation of a physical activity intervention in primary care settings: Lessons learned. Health Promot. Pract. 2013, 14, 81–87. [Google Scholar] [CrossRef] [PubMed]
- Williams, D.J.; Strean, W.B. Physical activity promotion in social work. Soc. Work 2006, 51, 180–184. [Google Scholar] [CrossRef] [PubMed]
- U.S. Census Bureau. Growth in Urban Population Outpaces Rest of Nation, Census Bureau Reports. 2012. Available online: https://www.census.gov/newsroom/releases/archives/2010_census/cb12-50.html (accessed on 11 December 2021).
- Cole, D.A.; Maxwell, S.E. Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. J. Abnorm. Psychol. 2003, 112, 558–577. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bartlett, J. Handling Missing Data in Stata—A Whirlwind Tour. 2012 Italian Stata Users Group Meeting. 2012. Available online: https://www.stata.com/meeting/italy12/abstracts/materials/it12_bartlett.pdf (accessed on 11 December 2021).
Item | N (%) | Weighted % (Proportion) |
---|---|---|
Gender | ||
Female | 70,336 (55.2) | 51.5 |
Male | 57,034 (44.8) | 48.5 |
Age | ||
18–24 | 7458 (5.9) | 11.9 |
25–34 | 12,831 (10.1) | 16.4 |
35–44 | 14,201 (11.1) | 15.4 |
45–54 | 18,374 (14.4) | 15.8 |
55–64 | 26,047 (20.5) | 17.1 |
65 and older | 48,459 (38.0) | 23.4 |
Race | ||
White, Non-Hispanic | 100,019 (78.5) | 70.5 |
Non-White | 27,351 (21.5) | 29.5 |
Education Attainment | ||
Did not graduate high school | 9903 (7.8) | 11.8 |
Graduated high school | 36,694 (28.9) | 30.7 |
Attended or graduated college | 80,248 (63.3) | 57.5 |
Employment Status | ||
Employed for wage or self-employed | 59,769 (38.9) | 55.8 |
Unemployed or unable to work | 15,769 (12.6) | 12.8 |
A homemaker or a student | 9153 (7.3) | 10.2 |
Retired | 40,836 (32.5) | 21.1 |
Marital Status | ||
Divorced, widowed, sepa rated, or never married | 58,889 (46.58) | 45.2 |
Married or a member of an unmarried couple | 67,543 (53.42) | 54.8 |
Healthcare Coverage | ||
Covered | 11,5951 (91.5) | 91.5 |
Not covered | 10,787 (8.5) | 8.5 |
Chronic Diseases | ||
1 or more diseases | 77,426 (60.8) | 51.5 |
No chronic disease | 49,944 (39.2) | 48.5 |
BMI | ||
BMI < 25 (Not overweight or obese) | 35,507 (30.5) | 31.9 |
BMI ≥ 25 (Overweight or obese) | 81,011 (69.5) | 68.1 |
Item | N (%) | Weighted % (Proportion) | |
---|---|---|---|
HRQOL | |||
Poor physical health | 18,946 (15.3) | 13.5 | |
Poor mental health | 16,205 (13.0) | 14.4 | |
ACE | |||
0 ACEs | 41,729 (42.3) | 37.3 | |
1–2 ACEs | 35,073 (35.6) | 36.5 | |
3+ ACEs | 21,795 (22.1) | 26.1 | |
Child Abuse | |||
Yes | 37,559 (36.9) | 40.1 | |
Household dysfunction | |||
Yes | 48,485 (47.4) | 52.8 | |
PA Level | |||
Inactive | 36,812 (32.5) | 30.9 | |
Insufficiently active | 20,527 (18.1) | 19.9 | |
Active | 18,399 (16.2) | 17.2 | |
Highly Active | 37,663 (33.2) | 32.0 | |
Mean | SE | Range: Min–Max | |
HRQOL (Healthy days) | 22.48 | 0.06 | 0–30 |
Physically unhealthy days | 4.30 | 0.44 | 0–30 |
Mentally unhealthy days | 4.56 | 0.47 | 0–30 |
1. HRQOL | 2. Physically Unhealthy Days | 3. Mentally Unhealthy Days | 4. ACEs | 5.Child Abuse | 6. Household Dysfunction | 7. Physical Activity | |
---|---|---|---|---|---|---|---|
1. | 1 | ||||||
2. | −0.82 *** | 1 | |||||
3. | −0.73 *** | 0.33 *** | 1 | ||||
4. | −0.24 *** | 0.13 *** | 0.27 *** | 1 | |||
5. | −0.21 *** | 0.12 *** | 0.23 *** | 0.82 *** | 1 | ||
6. | −0.21 *** | 0.10 *** | 0.25 *** | 0.91 *** | 0.53 *** | 1 | |
7. | 0.19 *** | −0.20 *** | −0.11 *** | −0.03 *** | −0.01 *** | −0.03 *** | 1 |
Predictor | B | SE | β | t | 95% CI | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Model 1 (X1 * W → HRQOL); SRMR = 0.000 CD = 0.186 | ||||||
ACEs | −1.13 | 0.04 | −0.20 | −29.28 *** | −1.20 | −1.05 |
PA | 0.99 | 0.05 | 0.11 | 18.22 *** | 0.88 | 1.09 |
ACEs * PA | 0.03 | 0.03 | 0.01 | 1.00 | −0.03 | 0.09 |
Model 2 (X2 * W → HRQOL); SRMR = 0.000 CD = 0.179 | ||||||
Child abuse | −2.15 | 0.08 | −.18 | −27.39 *** | −2.31 | −2.00 |
PA | 1.00 | 0.05 | 0.11 | 18.22 *** | 0.89 | 1.11 |
Child abuse * PA | 0.15 | 0.06 | 0.02 | 2.39 * | 0.03 | 0.27 |
Model 3 (X3 * W → HRQOL); SRMR = 0.000 CD = 0.177 | ||||||
Household dysfunction | −1.14 | 0.06 | −0.18 | −25.81 *** | −1.55 | −1.33 |
PA | 0.98 | 0.05 | 0.11 | 18.52 *** | 0.88 | 1.08 |
Household dysfunction * PA | 0.03 | 0.04 | 0.004 | 0.61 | −0.06 | 0.11 |
Model 4 (X1 * W → Physically Unhealthy Days); SRMR = 0.000 CD = 0.162 | ||||||
ACEs | 0.49 | 0.03 | 0.11 | 16.12 *** | 0.43 | 0.55 |
PA | −0.98 | 0.04 | −0.14 | −23.18 *** | −1.06 | −0.90 |
ACEs * PA | −0.04 | 0.03 | −0.01 | −1.70 | −0.09 | 0.01 |
Model 5 (X2 * W → Physically Unhealthy Days); SRMR = 0.000 CD = 0.162 | ||||||
Child abuse | 0.99 | 0.06 | 0.10 | 16.23 *** | 0.87 | 1.11 |
PA | −0.99 | 0.04 | −0.14 | −23.17 *** | −1.07 | −0.90 |
Child abuse * PA | −0.13 | 0.05 | −0.02 | −2.51 * | −.23 | −0.03 |
Model 6 (X3 * W → Physically Unhealthy Days); SRMR = 0.000 CD = 0.159 | ||||||
Household dysfunction | 0.61 | 0.04 | 0.09 | 13.90 *** | 0.52 | 0.69 |
PA | −0.98 | 0.04 | −0.14 | −23.48 *** | −1.06 | −0.89 |
Household dysfunction * PA | −0.04 | 0.03 | −0.01 | −1.01 | −0.11 | 0.03 |
Model 7 (X1 * W → Mentally Unhealthy Days); SRMR = 0.000 CD = 0.147 | ||||||
ACEs | 0.97 | 0.03 | 0.22 | 29.38 *** | 0.91 | 1.04 |
PA | −0.36 | 0.05 | −0.05 | −7.77 *** | −0.45 | −0.27 |
ACEs * PA | −0.09 | 0.03 | −0.02 | −3.35 ** | −0.14 | −0.03 |
Model 8 (X2 * W → Mentally Unhealthy Days); SRMR = 0.000 CD = 0.136 | ||||||
Child abuse | 1.83 | 0.07 | 0.19 | 25.54 *** | 1.69 | 1.97 |
PA | −0.39 | 0.05 | −0.05 | −8.16 *** | −0.48 | −0.30 |
Child abuse * PA | −0.21 | 0.06 | −0.03 | −3.70 *** | −0.32 | −0.10 |
Model 9 (X3 * W → Mentally Unhealthy Days); SRMR = 0.000 CD = 0.137 | ||||||
Household dysfunction | 1.27 | 0.05 | 0.19 | 25.80 *** | 1.17 | 1.37 |
PA | −0.36 | 0.04 | −0.05 | −8.06 *** | −0.45 | −0.27 |
Household dysfunction*PA | −0.13 | 0.04 | −0.02 | −3.39 ** | −0.21 | −0.05 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Moon, I.; Han, J. Moderating Effects of Physical Activity on the Relationship between Adverse Childhood Experiences and Health-Related Quality of Life. Int. J. Environ. Res. Public Health 2022, 19, 668. https://doi.org/10.3390/ijerph19020668
Moon I, Han J. Moderating Effects of Physical Activity on the Relationship between Adverse Childhood Experiences and Health-Related Quality of Life. International Journal of Environmental Research and Public Health. 2022; 19(2):668. https://doi.org/10.3390/ijerph19020668
Chicago/Turabian StyleMoon, Ingyu, and Junghee Han. 2022. "Moderating Effects of Physical Activity on the Relationship between Adverse Childhood Experiences and Health-Related Quality of Life" International Journal of Environmental Research and Public Health 19, no. 2: 668. https://doi.org/10.3390/ijerph19020668