Understanding of Associations Between Different Types of Adverse Childhood Experiences and Adult Health Outcomes

Background/ Purpose

Adverse childhood experiences (ACEs) have long-lasting negative impacts on adults’ health outcomes in later life. ACEs consist of a wide range of adversities experienced in one’s childhood, including child maltreatment and exposure to unhealthy family environment. Studies suggest that individuals who had ever experienced any type of ACEs are at increased risk of being engaged in health risk behaviors or having negative physical/ mental health outcomes in later life. Most ACE-related studies report a dose-response association between the number of ACEs and the greater risk of impaired health outcomes in adulthood. However, few studies have investigated the effects of different types of adversity on adult health outcomes. ACEs are divided into two categories: child maltreatment (child abuse and neglect) and dysfunctional household environment (domestic violence, parental divorce/ separation, a household member’s substance abuse, mental illness, or incarceration). These distinct types of ACEs may differently affect adults’ health consequences. Although the dysfunctional household environment may seem to have less detrimental impacts than the child maltreatment on adult health outcomes, those who had ever been exposed to unhealthy or non-nurturing family environments demonstrated increased risk of mental, emotional, psychological, and behavioral disorders. Therefore, it is important to examine the associations between ACEs and adults’ wellbeing, paying particular attention to the different types of adversities.

Methods

The current study uses data from the 2014 Wisconsin Behavioral Risk Factor Survey, a cross-sectional telephone survey, to examine the associations between three types of ACEs and adults’ health risk behaviors and chronic health conditions. The analytic sample consists of 5,405 adults who completed a battery of measures to assess ACEs and negative health outcomes. Three types of ACEs (child abuse, child neglect, and household dysfunction) were measured through retrospective, self-report questionnaires that assess the occurrence of ACEs up to the age of 18 years. Adults’ health outcomes were measured in two domains, health risk behaviors and poor chronic health conditions, using self-report measures. Two sets of logistic regression models were estimated for each health outcome. The regression analyses contained a set of sociodemographic control variables.

Results

Results suggested that the exposure to dysfunctional household in childhood emerged as a statistically significant risk factor to both health risk behaviors and poor chronic health conditions in adulthood. Child abuse was significantly associated with adults’ negative chronic health outcomes; however, it appeared to have only a marginal impact on health risk behaviors. In addition, there was a lack of statistically significant association between child neglect and adult poor health outcomes.

Conclusions and Implications

The current study not only expands knowledge on the impacts of ACEs on adults’ health outcomes with particular attention to the different types of ACEs but also has practical implications: early interventions improving household environment should be emphasized to prevent adverse health outcomes in later life. Growing up in a dysfunctional household receive less attention than the direct maltreatment in the research and practice. The findings from this study support the fact that family environment is as important as direct experience of child maltreatment.