Yale University School of Nursing, Orange, CT, United States of America.
US Army, AMEDD Student Detachment, Joint Base San Antonio, Fort Sam Houston, TX, United States of America.
PLoS One. 2024 Mar 21;19(3):e0299918. doi: 10.1371/journal.pone.0299918. eCollection 2024.
Existing evidence shows that people who report Adverse Childhood Experiences (ACEs) are more likely to exhibit health-risk behaviors. However, limited research on this topic pertains to oncology population. We aim to address this knowledge gap by estimating the prevalence of ACEs and investigating their association with self-reported health-risk behaviors among adult cancer survivors living in the U.S.
We conducted a secondary analysis using cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System ACE module. We included 4,126 adults, aged ≥18 years, with a history of cancer. The outcome variable was self-reported health-risk behaviors, which included cigarette smoking, e-cigarette use, and binge alcohol drinking. Self-reported ACEs history was the primary independent variable, comprised of 11 questions regarding child abuse and dysfunctional households. We conducted descriptive statistics and multivariable logistic regression to describe the relationship between the ACE history and health-risk behaviors.
Overall, 84.2% of cancer survivors self-reported as White, 58.4% were women, and 76.6% were aged 65+ years. Nearly two-thirds of the sample (63.2%) self-reported at least one ACE (prior to age 18) and 21.7% engaged in ≥1 health-risk-behaviors, such as cigarette smoking, binge alcohol drinking, or e-cigarette use. Experiencing ≥3 ACEs was associated with 145% increased odds of reporting at least one health-risk behavior (OR = 2.45, 95% CI [1.78-3.38]) when compared to those without a history of ACEs. Besides, survivors who were younger, divorced, less educated, and had low income had higher odds of reporting at least one health-risk behavior.
Overall, a history of ACEs is associated with health-risk behaviors. These all can negatively impact cancer survivors' overall well-being. Early screening for ACE during oncologic visits can be a protective measure for preventing health-risk behaviors among cancer survivors.
现有证据表明，报告遭遇过不良童年经历（ACEs）的人更有可能表现出健康风险行为。然而，关于这一主题的研究有限，涉及肿瘤患者人群。我们旨在通过估计 ACE 的患病率并调查其与美国成年癌症幸存者报告的健康风险行为之间的关联来填补这一知识空白。
我们使用 2021 年行为风险因素监测系统 ACE 模块的横断面数据进行了二次分析。我们纳入了 4126 名年龄≥18 岁、有癌症病史的成年人。因变量为自我报告的健康风险行为，包括吸烟、电子烟使用和 binge 饮酒。自我报告的 ACE 史是主要的独立变量，由 11 个关于儿童虐待和功能失调家庭的问题组成。我们进行了描述性统计和多变量逻辑回归，以描述 ACE 史与健康风险行为之间的关系。
总体而言，84.2%的癌症幸存者自我报告为白人，58.4%为女性，76.6%年龄在 65 岁及以上。近三分之二的样本（63.2%）自我报告至少经历过一次 ACE（18 岁之前），21.7%存在至少一种健康风险行为，如吸烟、 binge 饮酒或电子烟使用。与没有 ACE 史的人相比，经历≥3 次 ACE 与报告至少一种健康风险行为的几率增加 145%相关（OR=2.45，95%CI[1.78-3.38]）。此外，年龄较小、离婚、受教育程度较低和收入较低的幸存者报告至少一种健康风险行为的几率更高。
总体而言，ACE 史与健康风险行为相关。这些都可能对癌症幸存者的整体健康产生负面影响。在肿瘤就诊期间进行 ACE 早期筛查可以是预防癌症幸存者健康风险行为的保护措施。
