Background and Purpose: Research on adverse childhood experiences (ACEs) has shown that greater levels of early adversity foreshadow poor physical and mental health outcomes over the life course. A similar measurement approach may advance the study of cumulative risk in adulthood. This investigation uses data from the Families and Children Thriving (FACT) Study to examine the properties of a new measure of adult adversity. We describe the prevalence of 10 major adversities and assess their interrelations. We also examine the internal consistency and factor structure of the items. Last, we test associations between a cumulative index of adult adversity and a panel of health-related outcomes.
Methods: The FACT Study is a longitudinal investigation of low-income families in Wisconsin that received evidence-based home visiting services. The present study comprises 1,161 women who completed a postpartum survey, which included a 19-item measure of adverse adult experiences. We used the measure to code 10 dichotomous adversities, five of which reference a former or current partner or spouse: physical abuse, emotional abuse, substance abuse, mental health problems, and incarceration. A sixth indicator of adversity, sexual assault, denotes forced sexual contact by a partner/spouse or another adult perpetrator. The four remaining adversities are chronic financial problems, homelessness, discrimination, and crime victimization.
Descriptive analyses were performed to assess the prevalence of each adversity. We then tested zero-order correlations (phi) and Kuder-Richardson (KR-20) estimates of internal consistency among all adversities. Next, a confirmatory factor analysis was performed to examine the underlying structure of the instrument. Finally, multivariate analyses were used to test associations between a 10-item adversity index and five self-reported outcomes: global physical health, posttraumatic stress, depression, smoking, and substance use problems. All outcomes were measured at the same time adult adversity was reported as well as a second time point one year later.
Results: The reported prevalence of each adversity exceeded 20%. The most frequently endorsed adversities were partner/spouse emotional abuse (58.2%) and incarceration (48.8%). All 10 adversities were significantly intercorrelated (p <.01). Kuder-Richardson estimates indicate that the measure had good internal consistency reliability (ρ KR20= .81). A confirmatory factor analysis revealed a two-factor solution that distinguished between partner/spouse risk factors and other ecological adversities such as financial problems and discrimination; the model fit the data well (χ2(33)= 236.96, p <.001, CFI =.98, TFI =.98, RMSEA =.07). Controlling for age, race/ethnicity, education, and ACEs, adult adversity scores were significantly associated with concurrent reports of physical health (B= -.38, p <.001), depression (OR= 1.42, p <.001), posttraumatic stress (OR= 1.48, p <.001), smoking (OR= 1.20, p <.001), and substance use (OR= 1.37, p <.001). Tests of the same outcomes one year later produced similar results.
Conclusions and Implications: In this sample of low-income women, 10 major adversities were common, correlated, and consequential. Building on lessons learned from the ACE literature, a validated assessment of adult adversity holds the promise of assimilating interrelated phenomena and integrating fields of research. Implications for predictive modeling, prevention, and intervention will be discussed.