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Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Children's Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 55166

Special Issue Editors

Dr. Alexander Testa

E-Mail Website
Guest Editor
Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX 78207, USA
Interests: incarceration; adverse childhood experiences; criminal justice; social determinants of health
Dr. Dylan B. Jackson

E-Mail Website
Guest Editor
Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD 21205, USA
Interests: child and adolescent health; criminal justice; adverse childhood experiences; health equity
Prof. Dr. Michael G. Vaughn

E-Mail Website
Guest Editor
School of Social Work, Saint Louis University, Saint Louis, MO 63103, USA
Interests: etiology of antisocial and violent behavior; delinquency; developmental and biosocial criminology

Special Issue Information

Dear Colleagues,

Experiences that occur during childhood and adolescence can carry short- and long-term ramifications for health and wellbeing over the life-course. In particular, adverse childhood experiences (ACEs; e.g., abuse, parental/household challenges, and neglect) are increasingly recognized as important contributors to deleterious health outcomes. Indeed, existing research links ACEs to various health and developmental problems including poorer mental health, chronic health conditions, inhibited social development, and increases in internalizing and externalizing behaviors. Nonetheless, there remains much to be learned regarding the impact of ACEs for health over stages of the life-course. This Special Issue offers an opportunity to publish high-quality, interdisciplinary research that contributes to knowledge in this area. Suitable articles include theoretical articles, empirical research manuscripts, (quantitative, qualitative, and mixed-methods), systematic reviews, meta-analyses, and evidence-based interventions focused on the health consequences of ACEs at different points in the life-course. Studies that examine the impact of ACEs on markers of physical health, psychological health, and health behaviors, as well as internalizing and externalizing behaviors, are welcomed.

Dr. Alexander Testa
Dr. Dylan B. Jackson
Prof. Dr. Michael G. Vaughn
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • adverse childhood experiences
  • health
  • life-course
  • wellbeing
  • children

Published Papers (22 papers)

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Research

15 pages, 394 KiB  
Article
Childhood Bereavement, Adverse and Positive Childhood Experiences, and Flourishing among Chinese Young Adults
by Krista P. Woodward, Zhiyuan Yu, Wenyi Chen, Tingting Chen, Dylan B. Jackson, Terrinieka W. Powell and Lin Wang
Int. J. Environ. Res. Public Health 2023, 20(5), 4631; https://doi.org/10.3390/ijerph20054631 - 06 Mar 2023
Cited by 4 | Viewed by 2026
Abstract
Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). [...] Read more.
Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). In a cross-sectional observational study, we examined how ACEs, PCEs, and adult flourishing differs by self-reported CB history among 9468 Chinese young adults (18–35 years), of which 4.3% experienced CB (n = 409). Data collection included convenience sampling among university students in Mainland China. Respondents voluntarily completed an online survey between August and November 2020. Descriptive statistics, chi-square tests, and logistic regressions examined frequencies and differences in ACEs, PCEs, and flourishing by the history of CB controlling for a few demographic covariates. Bereaved individuals reported significantly higher ACEs and lower PCEs. The odds of experiencing emotional, physical, and sexual abuse as well as household substance abuse, parental mental illness, and parental incarceration ranged from 2.0–5.2 times higher for bereaved individuals. Bereaved participants also reported significant negative relationships with Flourishing Index (β = −0.35, t = −4.19, p < 0.001) and Secure Flourishing Index (β = −0.40, t = −4.96, p < 0.001). Consistent with previous research, our findings demonstrate the lasting effects of CB on well-being. We discuss study implications for ACEs and PCEs screening and surveillance as well as grief counseling to promote flourishing among bereaved youth in China and beyond. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
18 pages, 426 KiB  
Article
Adverse Childhood Experiences and Adolescent Delinquency: A Theoretically Informed Investigation of Mediators during Middle Childhood
by Dylan B. Jackson, Melissa S. Jones, Daniel C. Semenza and Alexander Testa
Int. J. Environ. Res. Public Health 2023, 20(4), 3202; https://doi.org/10.3390/ijerph20043202 - 11 Feb 2023
Cited by 7 | Viewed by 3212
Abstract
Objective: The purposes of this study are twofold. First, we explore the associations between cumulative ACEs at ages 5 and 7 and delinquency at age 14 in a national sample of youth in the United Kingdom (UK). Second, we explore the role of [...] Read more.
Objective: The purposes of this study are twofold. First, we explore the associations between cumulative ACEs at ages 5 and 7 and delinquency at age 14 in a national sample of youth in the United Kingdom (UK). Second, we explore the role of five theoretically relevant mediators in explaining this relationship. Methods: Analyses were based on data from the UK Millennium Cohort Study—a prospective, longitudinal birth-cohort study of more than 18,000 individuals in the United Kingdom. Results: The results indicate that early ACEs are significantly associated with adolescent delinquency, with effects becoming significantly larger as ACEs accumulate. Findings also reveal that child property delinquency, substance use, low self-control, unstructured socializing, and parent–child attachment at age 11 all significantly mediate the relationship between early ACEs and delinquency in adolescence, with early delinquency and low self-control emerging as the most robust mediators. Conclusions: Findings point to a need for early ACEs screening and a Trauma-Informed Health Care (TIC) approach in early delinquency prevention efforts. Early intervention efforts that bolster child self-control and curtail early-onset problem behaviors may also disrupt pathways from ACEs to adolescent delinquency. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
9 pages, 722 KiB  
Article
Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores
by Fahad M. Alhowaymel, Karen A. Kalmakis, Lisa M. Chiodo, Nicole M. Kent and Maha Almuneef
Int. J. Environ. Res. Public Health 2023, 20(2), 1651; https://doi.org/10.3390/ijerph20021651 - 16 Jan 2023
Cited by 9 | Viewed by 2764
Abstract
Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different [...] Read more.
Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different cut-points to define high scores. The aim of this study is to clarify a cut-point at which ACEs are significantly associated with negative chronic health outcomes. To accomplish this aim, a secondary analysis using data from a cross-sectional study was conducted. The Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used for data collection. Descriptive statistics, nonparametric regression, and logistic regression analyses were performed on a sample of 10,047 adults. Data from demographic and self-report health measures were included. The results showed that a cut-point of four or more ACEs was significantly associated with increased rates of chronic disease. Participants with at least one chronic disease were almost 3 times more likely (OR = 2.8) to be in the high ACE group. A standardized cut-point for ACE scores will assist in future research examining the impact of high ACEs across cultures to study the effect of childhood experiences on health. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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14 pages, 317 KiB  
Article
The Long-Term Effect of Famine Exposure on Cognitive Performance: Evidence from the 1959–1961 Chinese Famine
by Han Zhang and Wing Chung Ho
Int. J. Environ. Res. Public Health 2022, 19(24), 16882; https://doi.org/10.3390/ijerph192416882 - 15 Dec 2022
Cited by 1 | Viewed by 1063
Abstract
We examined the long-term impact of the 1959–1961 Chinese Famine on the survivors’ cognitive performance in this study. Using data from the 2010 China Family Panel Study, our cohort comparison analysis showed that people who experienced the famine in early childhood (aged 1–3) [...] Read more.
We examined the long-term impact of the 1959–1961 Chinese Famine on the survivors’ cognitive performance in this study. Using data from the 2010 China Family Panel Study, our cohort comparison analysis showed that people who experienced the famine in early childhood (aged 1–3) had a lower score on a vocabulary test and that those who were exposed to the famine in utero did not differ from those born after the famine, probably due to positive selection for the in utero survivors. To deal with the problem of the lack of a comparable control group, we further applied a migrant–stayer comparison approach, with data from the 2016 China Family Panel Study and the 2017 Hong Kong Panel Study of Social Dynamics, to examine the effects of famine exposure at different life stages on adult cognition. We compared the people who stayed in Guangdong with the people who crossed the border to Hong Kong before the famine. The results showed that Guangdong stayers who experienced the famine when they were aged 1–18 had worse performance in immediate word recall. The findings suggested that exposure to malnutrition during childhood has long-term adverse effects on cognitive performance. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
10 pages, 331 KiB  
Article
Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study
by Kat Ford, Karen Hughes, Katie Cresswell, Nel Griffith and Mark A. Bellis
Int. J. Environ. Res. Public Health 2022, 19(23), 16036; https://doi.org/10.3390/ijerph192316036 - 30 Nov 2022
Cited by 2 | Viewed by 1537
Abstract
Unintentional injury is a significant cause of disease burden and death. There are known inequalities in the experience of unintentional injuries; however, to date only a limited body of re-search has explored the relationship between exposure to adverse childhood experiences (ACEs) and unintentional [...] Read more.
Unintentional injury is a significant cause of disease burden and death. There are known inequalities in the experience of unintentional injuries; however, to date only a limited body of re-search has explored the relationship between exposure to adverse childhood experiences (ACEs) and unintentional injury. Using a cross-sectional sample of the adult general public (n = 4783) in Wales (national) and England (Bolton Local Authority), we identify relationships between ACE exposure and experience of car crashes and burns requiring medical attention across the life course. Individuals who had experienced 4+ ACEs were at significantly increased odds of having ever had each outcome measured. Furthermore, compared to those with no ACEs, those with 4+ were around two times more likely to report having had multiple (i.e., 2+) car crashes and over four times more likely to report having had burns multiple times. Findings expand the evidence base for the association between ACEs and negative health consequences and emphasise the need for effective interventions to prevent ACEs and their impact on life course health and well-being. Such knowledge can also be used to develop a multifaceted approach to injury prevention. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
16 pages, 541 KiB  
Article
Positive Childhood Experiences Associate with Adult Flourishing Amidst Adversity: A Cross Sectional Survey Study with a National Sample of Young Adults
by Zhiyuan Yu, Lin Wang, Wenyi Chen, Juan Zhang and Amie F. Bettencourt
Int. J. Environ. Res. Public Health 2022, 19(22), 14956; https://doi.org/10.3390/ijerph192214956 - 13 Nov 2022
Cited by 9 | Viewed by 2211
Abstract
The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we [...] Read more.
The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18–35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = −0.060 [−0.071, −0.049], p < 0.001, adjusted R2 = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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14 pages, 955 KiB  
Article
Childhood Adversity and Risky Behaviors among Chinese Rural Young Adults: The Mediation Effect of Perceived Stress and Moderation Effect of Social Support
by Lixia Zhang, Liwei Zhang and Alexander Testa
Int. J. Environ. Res. Public Health 2022, 19(20), 13194; https://doi.org/10.3390/ijerph192013194 - 13 Oct 2022
Viewed by 1532
Abstract
Research has documented that adverse childhood experiences (ACEs) significantly impact young people’s risky behaviors. Yet, few studies have explored if individuals’ perceived stress mediates the association between ACEs and risky behaviors; also if social support moderates the pathways from ACEs to risky behaviors [...] Read more.
Research has documented that adverse childhood experiences (ACEs) significantly impact young people’s risky behaviors. Yet, few studies have explored if individuals’ perceived stress mediates the association between ACEs and risky behaviors; also if social support moderates the pathways from ACEs to risky behaviors through perceived stress. This study aimed to assess the mediation effect of perceived stress and the moderation effect of social support in the study of ACEs and risky behaviors. This study sample includes 1091 Chinese rural young people. A web-based survey was used to assess demographic information, ACEs, perceived stress, social support, and seven types of risky behaviors. Multivariate regression models were run to test associations between ACEs and different risky behaviors while controlling for confounding variables. The mediation model (Model 4) and the moderated mediation model (Model 58) were also performed using the PROCESS macro. Multivariate regression results showed that, with increasing ACEs values, there was an increased likelihood of all risky behaviors. The moderated mediation analysis confirmed that perceived stress mediated the linkage between ACEs and risky behaviors. However, no significant moderating effect of social support was found. The study findings indicate that ACEs, risky behaviors, and perceived stress are significant public health problems among rural Chinese young people. Culturally appropriate prevention and intervention programs and services need to be implemented to address these issues and promote rural Chinese young people’s wellbeing and development. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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17 pages, 1131 KiB  
Article
Adverse Childhood Experiences and COVID-19 Stress on Changes in Mental Health among Young Adults
by Meshari A. Alradhi, Jessy Moore, Karen A. Patte, Deborah D. O’Leary and Terrance J. Wade
Int. J. Environ. Res. Public Health 2022, 19(19), 12874; https://doi.org/10.3390/ijerph191912874 - 08 Oct 2022
Cited by 3 | Viewed by 1687
Abstract
The COVID-19 pandemic has been linked to poor mental health outcomes and may be particularly damaging for young adults who may be more affected by governmental pandemic responses such as mandatory school and work closures, online schooling, and social isolation. Exposure to Adverse [...] Read more.
The COVID-19 pandemic has been linked to poor mental health outcomes and may be particularly damaging for young adults who may be more affected by governmental pandemic responses such as mandatory school and work closures, online schooling, and social isolation. Exposure to Adverse Childhood Experiences (ACEs) has also been shown to have a significant impact on mental health among young adults. This prospective study examined whether young adults with higher ACE profiles were more vulnerable to COVID-19 stressors. Using pre-COVID-19 data from the Niagara Longitudinal Heart Study and a follow-up online survey during COVID-19, we examined 171 young adults and found that high COVID-19-related stress, especially emotional and relationship stress, led to a greater reduction in mental health among young adults with higher levels of ACEs. Findings indicate that young adults with high ACE profiles may benefit from resources and intervention programs directed at mental health in times of crisis, such as the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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6 pages, 290 KiB  
Communication
Parental Adverse Childhood Experiences and Perpetration of Child Physical Punishment in Wales
by Karen Hughes, Kat Ford, Mark A. Bellis and Rebekah Amos
Int. J. Environ. Res. Public Health 2022, 19(19), 12702; https://doi.org/10.3390/ijerph191912702 - 04 Oct 2022
Cited by 1 | Viewed by 1716
Abstract
Child physical punishment is harmful to children and, as such, is being prohibited by a growing number of countries, including Wales. Parents’ own childhood histories may affect their risks of using child physical punishment. We conducted a national cross-sectional survey of Welsh adults [...] Read more.
Child physical punishment is harmful to children and, as such, is being prohibited by a growing number of countries, including Wales. Parents’ own childhood histories may affect their risks of using child physical punishment. We conducted a national cross-sectional survey of Welsh adults and measured relationships between the number of adverse childhood experiences (ACEs) parents (n = 720 with children aged < 18) had suffered during childhood and their use of physical punishment towards children. Overall, 28.2% of parents reported having ever physically punished a child, and 5.8% reported having done so recently (in the last year). Child physical punishment use increased with the number of ACEs parents reported. Parents with 4+ ACEs were almost three times more likely to have ever physically punished a child and eleven times more likely to have done so recently (vs. those with 0 ACEs). The majority (88.1%) of parents that reported recent child physical punishment had a personal history of ACEs, while over half reported recently having been hit themselves by a child. Child physical punishment is strongly associated with parents’ own ACE exposure and can occur within the context of broader conflict. Prohibiting physical punishment can protect children and, with appropriate family support, may help break intergenerational cycles of violence. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
18 pages, 544 KiB  
Article
Adverse Childhood Experiences and Cardiovascular Risk among Young Adults: Findings from the 2019 Behavioral Risk Factor Surveillance System
by Dylan B. Jackson, Alexander Testa, Krista P. Woodward, Farah Qureshi, Kyle T. Ganson and Jason M. Nagata
Int. J. Environ. Res. Public Health 2022, 19(18), 11710; https://doi.org/10.3390/ijerph191811710 - 16 Sep 2022
Cited by 5 | Viewed by 2225
Abstract
Background: Heart disease is the fourth leading cause of death for young adults aged 18–34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a [...] Read more.
Background: Heart disease is the fourth leading cause of death for young adults aged 18–34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a contemporary, national sample to examine the association between ACEs and cardiovascular health among young adults in the United States, as well as potential mediating pathways. Methods: The present study uses data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine associations between ACEs and cardiovascular risk, as well as the role of cumulative disadvantage and poor mental health in these associations. Results: Findings indicate that young adults who have experienced a greater number of ACEs have a higher likelihood of having moderate to high cardiovascular risk compared to those who have zero or few reported ACEs. Moreover, both poor mental health and cumulative disadvantage explain a significant proportion of this association. Conclusions: The present findings suggest that young adulthood is an appropriate age for deploying prevention efforts related to cardiovascular risk, particularly for young adults reporting high levels of ACEs. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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17 pages, 361 KiB  
Article
Adverse Childhood Experiences and Education Outcomes among Adolescents: Linking Survey and Administrative Data
by Ashley Stewart-Tufescu, Shannon Struck, Tamara Taillieu, Samantha Salmon, Janique Fortier, Marni Brownell, Mariette Chartier, Alexa R. Yakubovich and Tracie O. Afifi
Int. J. Environ. Res. Public Health 2022, 19(18), 11564; https://doi.org/10.3390/ijerph191811564 - 14 Sep 2022
Cited by 2 | Viewed by 2671
Abstract
It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs [...] Read more.
It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs and adolescents’ self-reported education outcomes and provincial education assessments among adolescents in Manitoba, Canada. Data were gathered from 1002 adolescents who participated in the Well-Being and Experiences (WE) Study. A subsample of the adolescents (84%) consented to having their WE survey data linked to administrative education databases. Binary and multinomial logistic regression models were computed to examine associations between ACE history and self-reported education outcomes and provincial education assessments, adjusting for sociodemographic variables. Adolescents with an ACE history had significantly increased likelihood of having ever been suspended from school (adjusted odds ratio (aOR) = 3.33, 95% CI 1.60–6.92), of lower grades (adjusted relative risk ratio (aRRR) = 3.21, 95% CI 1.42–7.29), and of chronic school absenteeism (aRRR = 2.45, 95% CI 1.28–4.68) compared with adolescents without an ACE history after adjusting for sociodemographic variables. Findings from this study illuminate the important relationship between childhood adversity and poor education outcomes assessed directly by adolescents. Increasing awareness of the public health risk associated with ACEs and education outcomes may inform education policy and school-based interventions. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
21 pages, 770 KiB  
Article
The Social Determinants of Adverse Childhood Experiences: An Intersectional Analysis of Place, Access to Resources, and Compounding Effects
by Sayil Camacho and Sarah Clark Henderson
Int. J. Environ. Res. Public Health 2022, 19(17), 10670; https://doi.org/10.3390/ijerph191710670 - 27 Aug 2022
Cited by 8 | Viewed by 3698
Abstract
Children across all races/ethnicities and income levels experience adverse childhood experiences (ACEs); however, historically excluded children and families must contend with added adversities across ecological levels and within higher-risk conditions due to systemic inequality. In this grounded theory study, the authors examined how [...] Read more.
Children across all races/ethnicities and income levels experience adverse childhood experiences (ACEs); however, historically excluded children and families must contend with added adversities across ecological levels and within higher-risk conditions due to systemic inequality. In this grounded theory study, the authors examined how health and social service providers (N = 81) from rural and urban counties in Tennessee provided services to low-income families, children exposed to opioids, and children of immigrants. Guided by an intersectional framework, the authors examined how rural and urban settings shaped higher risk conditions for ACEs and impeded access to resources at the individual, group, and community levels. Findings from this study identified additionally marginalized subpopulations and demonstrated how inequitable environments intersect and compound the effects of ACEs. The authors present their Intersectional Nature of ACEs Framework to showcase the relationship between high-risk conditions and sociopolitical and economic circumstances that can worsen the effects of ACEs. Ultimately, the Intersectional Nature of Aces Framework differentiates between ACEs that are consequences of social inequities and ACEs that are inflicted directly by a person. This framework better equips ACEs scholars, policymakers, and stakeholders to address the root causes of inequality and mitigate the effects of ACEs among historically excluded populations. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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12 pages, 512 KiB  
Article
Social and Behavioral Pathways between Adverse Childhood Experiences and Poor Adult Physical Health: Mediation by Early Adulthood Experiences in a Low-Income Population
by Claire Devine and Hannah Cohen-Cline
Int. J. Environ. Res. Public Health 2022, 19(17), 10578; https://doi.org/10.3390/ijerph191710578 - 25 Aug 2022
Viewed by 2005
Abstract
Adverse childhood experiences (ACEs) increase the risk of poor health and wellbeing in adulthood. In this study, we tested whether experiences in early adulthood—intimate partner violence (IPV), substance use, social isolation, and work instability—mediate the relationship between ACEs and poor physical health in [...] Read more.
Adverse childhood experiences (ACEs) increase the risk of poor health and wellbeing in adulthood. In this study, we tested whether experiences in early adulthood—intimate partner violence (IPV), substance use, social isolation, and work instability—mediate the relationship between ACEs and poor physical health in later adulthood. Using data from a large-scale survey of Medicaid enrollees in the Portland metropolitan area, four separate mediation models were constructed to assess the indirect effects of each early adulthood experience and the proportion of the total effect on physical health accounted for by the pathway. Experiencing four or more ACEs increased the risk of poor adult physical health by 50% (RR 1.50). Considered in separate models, mediation by IPV accounted for 14.4% of the total effect; substance use mediated a similar proportion (14.0%). Social isolation was a less substantial mediator (7.6%). Work instability did not mediate the relationship between ACEs and adult physical health in our population. These findings provide evidence that IPV, substance use, and social isolation in early adulthood are part of the pathway between high ACEs and poor adult physical health. Intervening to prevent negative early adult experiences may mitigate some of the long-term effects of childhood trauma on health. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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11 pages, 329 KiB  
Article
Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population
by Kristin Lyon-Scott and Hannah Cohen-Cline
Int. J. Environ. Res. Public Health 2022, 19(16), 10149; https://doi.org/10.3390/ijerph191610149 - 16 Aug 2022
Cited by 2 | Viewed by 1507
Abstract
Adverse childhood experiences (ACEs) are widely prevalent but unevenly distributed in the United States, with disadvantaged groups, especially those with low socioeconomic status, being more likely to experience them. ACEs have been linked to poor health outcomes in adulthood. In this study, we [...] Read more.
Adverse childhood experiences (ACEs) are widely prevalent but unevenly distributed in the United States, with disadvantaged groups, especially those with low socioeconomic status, being more likely to experience them. ACEs have been linked to poor health outcomes in adulthood. In this study, we examined the association between ACEs and emergency department (ED) utilization using a cross-sectional life-course survey of low-income adults matched to Medicaid enrollment and claims data. Surveys were obtained from 2348 Medicaid-enrolled adults in the Portland, OR metropolitan area; 1133 were used in this analysis. We used a two-part regression model to estimate the association between ACE score and both ever using the ED and frequency of ED use in the year after survey completion. We also evaluated a set of potentially protective factors to see if they impacted the relationship between ED use and ACE score. We found that participants with a higher ACE score were more likely to obtain any emergency services care (odds ratio (OR) = 1.11, p = 0.011), but ACE score did not predict how frequently they would utilize those services. Close social relationships were found to be protective against high ED utilization for those with high ACE scores. Upstream prevention efforts that identify places to intervene in childhood and incorporate trauma-informed strategies into ED care in adulthood have the potential to decrease ED use. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
13 pages, 355 KiB  
Article
Sex and Urban–Rural Differences in the Relationship between Childhood Sexual Abuse and Mental Health among Chinese College Students
by Rudong Zhang, Yun Liang, Wenzhen Cao, Leixiao Zeng and Kun Tang
Int. J. Environ. Res. Public Health 2022, 19(15), 9225; https://doi.org/10.3390/ijerph19159225 - 28 Jul 2022
Cited by 6 | Viewed by 2019
Abstract
This study aimed to reveal sex and urban–rural differences in the association between childhood sexual abuse (CSA) and mental health among Chinese college students. The study used data from the “National College Student Survey on Sexual and Reproductive Health 2019”, a cross-sectional study [...] Read more.
This study aimed to reveal sex and urban–rural differences in the association between childhood sexual abuse (CSA) and mental health among Chinese college students. The study used data from the “National College Student Survey on Sexual and Reproductive Health 2019”, a cross-sectional study conducted in all 31 provinces of mainland China. Weighted logistic regression analysis was conducted to determine the association between CSA (noncontact CSA, contact CSA, and penetrative CSA) and mental health (suicide attempts and mental disorders). Among 49,728 students, 39.42% of the male participants and 43.55% of the female participants had ever experienced CSA. According to the OR results of logistic regression analysis, compared to females, males in the contact CSA group (AOR: 3.49, 95% CI: 1.95–6.23) and the penetrative CSA group (AOR: 8.79, 95% CI: 3.15–24.52) had higher odds of suicide attempts. Participants from rural and suburban areas that were categorized in the penetrative CSA group were more likely to report suicide attempts (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban AOR: 4.86, 95% CI: 2.52–9.36) and mental disorders (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban: AOR: 4.86, 95% CI: 2.52–9.36). In conclusion, the findings revealed a high prevalence of CSA in both sexes and reported that males are more vulnerable to the adverse effects of CSA. In addition, we also found that undergraduates growing up in rural and suburban areas are more vulnerable to the adverse psychological effects of CSA. Policymakers should pay more attention to this vulnerable population and implement effective measures to alleviate mental trauma. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
15 pages, 2002 KiB  
Article
The Moderating Effect of Contact with Children on the Relationship between Adverse Childhood Experiences and Depression in Adulthood among a Chinese Adult Population
by Yufeng Zhao, Dianxi Wang and Feilun Du
Int. J. Environ. Res. Public Health 2022, 19(15), 8901; https://doi.org/10.3390/ijerph19158901 - 22 Jul 2022
Cited by 2 | Viewed by 1610
Abstract
The effect of adverse childhood experiences (ACEs) on depression in adulthood has been identified in many studies; however, the underlying mechanisms remain unclear. To understand the moderating effect of ACEs on depression, a moderation analysis using the interaction effect model was performed based [...] Read more.
The effect of adverse childhood experiences (ACEs) on depression in adulthood has been identified in many studies; however, the underlying mechanisms remain unclear. To understand the moderating effect of ACEs on depression, a moderation analysis using the interaction effect model was performed based on data obtained from the China Health and Retirement Longitudinal Study. This study found that people with ACEs had significantly lower depression scores than those without ACEs, particularly in categories such as physical abuse, emotional neglect, sibling death, parental illness/disability, parental depression, hunger, violence, and bullying. In addition, the results indicated that contact with children moderated the relationship between ACEs and depression in adulthood. Increased levels of contact with children reduced the adverse effects of parental drug abuse and the experience of starvation, but not physical abuse. This study highlights the role of family support in eliminating health disparities, which can reduce the effects of ACEs on depression in adulthood. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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13 pages, 356 KiB  
Article
Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys
by Sara K. Wood, Kat Ford, Hannah C. E. Madden, Catherine A. Sharp, Karen E. Hughes and Mark A. Bellis
Int. J. Environ. Res. Public Health 2022, 19(14), 8869; https://doi.org/10.3390/ijerph19148869 - 21 Jul 2022
Cited by 4 | Viewed by 2608
Abstract
Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs [...] Read more.
Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. Data from four cross-sectional ACE surveys with adult general populations in different regions of the UK from 2013–2015 (n = 12,788) were analysed. Data included participants’ demographics, ACE exposure, and four sexual health outcomes: having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection. ACE count was a consistent and significant predictor of all four sexual health outcomes for both males and females, with odds of these outcomes between three and seven times higher for those with 4+ ACEs compared to those with no ACEs. Increased risks of some, but not all, sexual health outcomes were also found with higher residential deprivation, younger age, being of white ethnicity, and being born to a teenage mother. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected. Ensuring that those living in deprived areas have access to services and that barriers to uptake are addressed is also key. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
16 pages, 416 KiB  
Article
Prevalence of Adverse Childhood Experiences in the First Decade of Life: A Study in the Portuguese Cohort, Generation XXI
by Sara Soares, Armine Abrahamyan, Mariana Amorim, Ana Cristina Santos and Sílvia Fraga
Int. J. Environ. Res. Public Health 2022, 19(14), 8344; https://doi.org/10.3390/ijerph19148344 - 08 Jul 2022
Cited by 2 | Viewed by 1830
Abstract
Adverse childhood experiences (ACEs) are a modifiable risk factor for diseases throughout life. This study estimates the prevalence of ACEs in children, addressing associated sociodemographic characteristics and examining the relationship of ACEs with the child’s health and behaviors. We used information on 5295 [...] Read more.
Adverse childhood experiences (ACEs) are a modifiable risk factor for diseases throughout life. This study estimates the prevalence of ACEs in children, addressing associated sociodemographic characteristics and examining the relationship of ACEs with the child’s health and behaviors. We used information on 5295 participants at 10 years old, of the birth cohort Generation XXI, established in Porto, Portugal. Children answered a self-administered questionnaire on ACEs, based on the original ACEs study. Principal component analysis was used to group correlated ACEs, and a score was computed to assess their cumulative effect. Overall, 96.2% of children reported having been exposed to at least one ACE. The most prevalent ACE was a household member shouting, yelling, or screaming at the child (57.7%). Boys were more likely than girls to report “abuse”, “school problems”, and “death/severe disease”. Low parental education, income, and unemployment were associated with an increased risk of “school problems”, “death/severe disease”, and “household dysfunction”. We observed that the dimensions of ACEs could be identified at 10 years of age. A disadvantaged socioeconomic environment was associated with dimensions of ACEs. These data illustrate the natural history of dimensions of ACEs and their potential social patterning. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
12 pages, 709 KiB  
Article
Associations between Adverse Childhood Experiences and Obesity in a Developing Country: A Cross-Sectional Study among Middle-Aged and Older Chinese Adults
by Li Lin, Weiqing Chen, Weidi Sun, Minyan Chen, Jinghua Li, Jichuan Shen and Vivian Yawei Guo
Int. J. Environ. Res. Public Health 2022, 19(11), 6796; https://doi.org/10.3390/ijerph19116796 - 02 Jun 2022
Cited by 8 | Viewed by 1890
Abstract
Background: The association between adverse childhood experiences (ACEs) and obesity in developing countries has been underexplored and inconsistent. Methods: This cross-sectional study used data of 10,054 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study. Information on 12 ACE [...] Read more.
Background: The association between adverse childhood experiences (ACEs) and obesity in developing countries has been underexplored and inconsistent. Methods: This cross-sectional study used data of 10,054 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study. Information on 12 ACE indicators was collected via questionnaires. General obesity was defined as a body mass index (BMI) of ≥28 kg/m². Central obesity was defined as a waist circumference of ≥90 cm for males and ≥85 cm for females. Logistic and linear regression analyses were conducted to evaluate the association of ACEs with general obesity, central obesity, BMI, and waist circumference where appropriate. Results: Compared to the non-exposed group, the experience of ≥3 ACEs was significantly associated with decreased risks of general obesity (OR = 0.83, 95% CI: 0.69, 0.999), central obesity (OR = 0.88, 95% 0.77, 0.997), and smaller BMI (β = −0.27, 95% CI: −0.50, −0.04) and waist circumference (β = −0.89, 95% CI: −1.52, −0.26). Compared to the high socioeconomic status (SES) group, such associations were more evident in those with a low SES, except for central obesity. Conclusion: ACEs were shown to be inversely associated with later-life obesity in China, especially in socioeconomically disadvantaged populations. The context-specific impacts reflect divergent roles of socioeconomic position in the obesity epidemic between developed and developing countries. Further investigations are needed to confirm whether physical activity could shift the direction of this association. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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11 pages, 735 KiB  
Article
Intergenerational Transmission of Trauma: The Mediating Effects of Family Health
by Emma M. Reese, Melissa Jane Barlow, Maddison Dillon, Sariah Villalon, Michael D. Barnes and AliceAnn Crandall
Int. J. Environ. Res. Public Health 2022, 19(10), 5944; https://doi.org/10.3390/ijerph19105944 - 13 May 2022
Cited by 8 | Viewed by 5132
Abstract
Family health is important to the well-being of individual family members and the collective family unit, and as such, may serve as a mediator for the intergenerational transmission of trauma (ITT). This study aimed to understand the intergenerational impact of parent’s adverse and [...] Read more.
Family health is important to the well-being of individual family members and the collective family unit, and as such, may serve as a mediator for the intergenerational transmission of trauma (ITT). This study aimed to understand the intergenerational impact of parent’s adverse and positive childhood experiences (ACEs and PCEs) on their children’s adverse family experiences (AFEs) and how family health mediated those relationships. The sample consisted of 482 heterosexual married or cohabiting couples (dyads) in the United States who had a child between the ages of 3 and 13 years old. Each member of the dyad completed a survey, and data were analyzed using structural equation modeling. Parental ACEs were associated with more AFEs. The fathers’, but not the mothers’, ACEs were associated with worse family health. Parental PCEs were associated with better family health, and family health was associated with lower AFE scores. Indirect effects indicated that parental PCEs decreased AFEs through their impact on family health. Family health also mediated the relationship between the father’s ACEs and the child’s AFEs. Interventions designed to support family health may help decrease child AFEs. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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19 pages, 1423 KiB  
Article
The Long-Term Health and Human Capital Consequences of Adverse Childhood Experiences in the Birth to Thirty Cohort: Single, Cumulative, and Clustered Adversity
by Sara N. Naicker, Marilyn N. Ahun, Sahba Besharati, Shane A. Norris, Massimiliano Orri and Linda M. Richter
Int. J. Environ. Res. Public Health 2022, 19(3), 1799; https://doi.org/10.3390/ijerph19031799 - 05 Feb 2022
Cited by 8 | Viewed by 3020
Abstract
Human capital—that is the cumulative abilities, education, social skills, and mental and physical health one possesses—is increasingly recognized as key to the reduction of inequality in societies. Adverse childhood experiences have been linked to a range of human capital indicators, with the majority [...] Read more.
Human capital—that is the cumulative abilities, education, social skills, and mental and physical health one possesses—is increasingly recognized as key to the reduction of inequality in societies. Adverse childhood experiences have been linked to a range of human capital indicators, with the majority of research in high-income, western settings. This study aims to examine the link between adverse childhood experiences and adult human capital in a South African birth cohort and to test whether associations differ by measurement of adversity. Secondary analysis of data from the Birth to Thirty study was undertaken. Exposure data on adversity was collected prospectively throughout childhood and retrospectively at age 22. Human capital outcomes were collected at age 28. Adversity was measured as single adverse experiences, cumulative adversity, and clustered adversity. All three measurements of adversity were linked to poor human capital outcomes, with risk for poor human capital increasing with the accumulation of adversity. Adversity was clustered by quantity (low versus high) and type (household dysfunction versus abuse). Adversity in childhood was linked to a broad range of negative outcomes in young adulthood regardless of how it was measured. Nevertheless, issues of measurement are important to understand the risk mechanisms that underlie the association between adversity and poor human capital. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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15 pages, 539 KiB  
Article
Parental Incarceration, Child Adversity, and Child Health: A Strategic Comparison Approach
by Dylan B. Jackson, Alexander Testa, Daniel C. Semenza and Michael G. Vaughn
Int. J. Environ. Res. Public Health 2021, 18(7), 3384; https://doi.org/10.3390/ijerph18073384 - 25 Mar 2021
Cited by 19 | Viewed by 4326
Abstract
Background: Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. Methods: The present study uses a large, nationally [...] Read more.
Background: Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. Methods: The present study uses a large, nationally representative sample to compare U.S. children who were exposed to parental incarceration to a strategic comparison group of U.S. children who were not exposed to parental incarceration, but were nonetheless exposed to alternative family stressors and adversities. Results: The initial findings generally reveal worse health among children exposed to parental incarceration compared to those who are not exposed. Even so, these differences were partially or completely attenuated when comparing the incarceration-exposed group to more comparable groups of children exposed to a varying degree of alternative stressors/adversities. Conclusions: Programmatic efforts targeting parental incarceration as a means of promoting child health may be enhanced by adequately addressing co-occurring family stressors and child adversities. Full article
(This article belongs to the Special Issue Adverse Childhood Experiences (ACEs) and the Life-Course Health Consequences)
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