Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; the Veterans Affairs Office of Patient Care Services, Office of Women's Health Services, Department of Veterans Affairs, Washington, District of Columbia.
Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington;
Am J Prev Med. 2015 Oct;49(4):573-82. doi: 10.1016/j.amepre.2015.03.020. Epub 2015 Jun 16.
Prevalence of adverse childhood experiences (ACE) and associations with adult health may vary by gender and military service. This study compares the gender-specific prevalence of ACE by military service and determines the associations of ACE with adult health risk factors and health-related quality of life (HRQOL).
This 2014 analysis used data from the 2011 and 2012 CDC Behavioral Risk Factor Surveillance System. Total ACE was operationalized as the number of reported ACE. Associations of total ACE with adult health risk factors were estimated using general linear models; associations with HRQOL were estimated using negative binomial regression. All analyses adjusted for age and race/ethnicity.
Those with military service had more total ACE than civilians. Higher ACE was associated with poorer HRQOL among women (physical health, military service, relative risk [RR]=1.20, 95% CI=1.09, 1.33; civilians, RR=1.18, 95% CI=1.17, 1.20; mental health, military service, RR=1.21, 95% CI=1.12, 1.32; civilians, RR=1.25, 95% CI=1.23, 1.26). Among men, these associations were somewhat attenuated in those with military service relative to civilians (physical health, military service, RR=1.13, 95% CI=1.09, 1.18; civilians, RR=1.20, 95% CI=1.17, 1.24; mental health, military service, RR=1.21, 95% CI=1.16, 1.27; civilians, RR=1.30, 95% CI=1.27, 1.34).
Relative to civilians, men and women with military service report more ACE, but associations of ACE with adult HRQOL are weaker among men with military service relative to civilians. There is a need to implement and disseminate evidence-based programs to prevent ACE and for research on the long-term health consequences of ACE in military populations.
不良儿童经历（ACE）的发生率及其与成年人健康的关联可能因性别和兵役而有所不同。本研究比较了兵役对 ACE 的性别特异性发生率，并确定了 ACE 与成年健康风险因素和健康相关生活质量（HRQOL）的关联。
本 2014 年分析使用了 2011 年和 2012 年疾病预防控制中心行为风险因素监测系统的数据。总 ACE 被定义为报告的 ACE 数量。使用一般线性模型估计总 ACE 与成年健康风险因素的关联；使用负二项回归估计与 HRQOL 的关联。所有分析均调整了年龄和种族/族裔。
有兵役的人 ACE 总数高于平民。较高的 ACE 与女性的较差 HRQOL 相关（身体健康，兵役，相对风险[RR]=1.20，95%置信区间[CI]=1.09，1.33；平民，RR=1.18，95%CI=1.17，1.20；心理健康，兵役，RR=1.21，95%CI=1.12，1.32；平民，RR=1.25，95%CI=1.23，1.26）。对于男性，与平民相比，兵役人群的这些关联有所减弱（身体健康，兵役，RR=1.13，95%CI=1.09，1.18；平民，RR=1.20，95%CI=1.17，1.24；心理健康，兵役，RR=1.21，95%CI=1.16，1.27；平民，RR=1.30，95%CI=1.27，1.34）。
与平民相比，有兵役的男性和女性报告的 ACE 更多，但与平民相比，兵役男性 ACE 与成年 HRQOL 的关联较弱。需要实施和传播预防 ACE 的循证计划，并开展关于军事人群 ACE 长期健康后果的研究。
