Pacific Institute for Research and Evaluation, Calverton, Maryland, United States of America.
School of Public Health, Curtin University, Perth, Australia.
PLoS One. 2020 Jan 28;15(1):e0226134. doi: 10.1371/journal.pone.0226134. eCollection 2020.
To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity.
We use data from the Behavioral Risk Factor Surveillance System for 14 states. Logistic regressions yield estimates of the direct associations of ACEs exposure with health outcomes net of health risk factors, and indirect ACEs-health associations via health risk factors. Models were estimated for California (N = 22,475) and pooled data from 13 states (N = 110,076), and also separately by state.
Exposure to ACEs is associated with significantly higher odds of smoking, heavy drinking, and obesity. Net of these health risk factors, there was a significant and graded relationship in California and the pooled 13-state data between greater ACEs exposure and odds of depression, asthma, COPD, arthritis, and cardiovascular disease. Four or more ACEs were less consistently associated across states with cancer and diabetes and a dose-response relationship was also not present. There was a wide range across individual states in the percentage change in health outcomes predicted for exposure to 4+ ACEs. ACEs-related smoking, heavy drinking, and obesity explain a large and significant proportion of 4+ ACEs associations with COPD and cardiovascular disease, however some effect, absent of risk behavior, remained.
ACE's associations with most of the health conditions persist independent of behavioral pathways but only asthma, arthritis, COPD, cardiovascular disease, and depression consistently exhibit a dose-response relationship. Our results suggest that attention to child maltreatment and household dysfunction, mental health treatment, substance abuse prevention and promotion of physical activity and healthy weight outcomes might mitigate some adverse health consequences of ACEs. Differences across states in the pattern of ACEs-health associations may also indicate fruitful areas for prevention.
检验童年逆境经历（ACEs）与健康结果之间的关系是否在各州之间相似，并且在 ACEs 与吸烟、大量饮酒和肥胖相关联的情况下仍然存在。
我们使用来自 14 个州的行为风险因素监测系统的数据。逻辑回归得出 ACEs 暴露与健康结果之间的直接关联的估计值，这些关联是通过健康风险因素得出的。为加利福尼亚州（N=22475）和 13 个州的汇总数据（N=110076）以及按州分别建立了模型。
暴露于 ACEs 与吸烟、大量饮酒和肥胖的可能性显著增加有关。在这些健康风险因素之外，加利福尼亚州和 13 个州的汇总数据中，ACEs 暴露程度与抑郁、哮喘、COPD、关节炎和心血管疾病的患病几率之间存在显著且分级的关系。在各州中，4 个或更多 ACEs 与癌症和糖尿病的关联并不一致，也不存在剂量反应关系。在预测暴露于 4+ ACEs 对健康结果的影响百分比方面，各州之间存在很大差异。ACEs 相关的吸烟、大量饮酒和肥胖，在很大程度上解释了 4+ ACEs 与 COPD 和心血管疾病的关联，但仍存在一些不存在风险行为的影响。
ACEs 与大多数健康状况的关联在独立于行为途径的情况下仍然存在，但只有哮喘、关节炎、COPD、心血管疾病和抑郁症一直表现出剂量反应关系。我们的结果表明，关注儿童虐待和家庭功能障碍、心理健康治疗、预防药物滥用和促进身体活动和健康体重的结果，可能会减轻 ACEs 的一些不良健康后果。各州之间 ACEs 与健康关联的模式差异也可能表明预防的有成效领域。
