The Effect of Adverse Childhood Experiences on Adult Health: 2012 North Carolina Behavioral Risk Factor Surveillance System Survey

Abstract

Objective: Adverse childhood experiences (ACEs) include emotional, physical and sexual abuse as well as household dysfunction experienced before age 18. Research has demonstrated that ACEs put individuals at increased risk for a wide variety of chronic mental, physical and emotional health problems in adulthood. Our objective was to estimate the prevalence of ACEs and examine their association with perceived health, health risks and chronic conditions among North Carolina adults.

Methods: In 2012, 10,383 adults responded to the ACE module included in the N.C. Behavioral Risk Factor Surveillance System (BRFSS) survey. These population-based data were used to calculate the prevalence of ACEs among North Carolina adults and to compare the risk for perceived poor health, health risks and chronic conditions in adulthood among individuals who experienced no ACEs, one to two ACEs and three to eight ACEs.

Results: More than half of respondents (57.6%) reported having experienced at least one ACE. Exposure to ACEs varied by age, sex, race, income and education. Multivariate analysis indicated a statistically significant increase in risk for current smoking, binge drinking, obesity, HIV risk behaviors, poor physical and mental health, activity limitation, chronic obstructive pulmonary disease, cardiovascular disease, arthritis, depression and disability with increasing ACE exposure, even after controlling for sex, age, race and education. An increased risk was also found for perceived poor health and chronic condition outcomes after additional adjustment for current smoking and obesity.

Conclusion: ACEs are prevalent among the general population of North Carolina and are significantly related to development of health risk behaviors and poor health outcomes in adulthood. Examining the epidemiology of ACEs and associated outcomes in North Carolina emphasizes the importance of a life course perspective and strengthens the argument for focusing on the prevention of ACEs as an effective long-term strategy for improving population health outcomes.