WITHDRAWN: Aces and Adolescent Subjective Health: Testing the Mediating Role of Sleep and the Moderating Role of Positive Childhood Experiences with Longitudinal Data

Background/Purpose: Adverse childhood experiences (ACEs) have been linked to poor adolescent and adult health outcomes. ACEs exposures happen during developmental stages when health foundations are established. Resilience studies, however, demonstrate that positive childhood experiences (PCEs) co-occur with ACEs and could counteract their effects. Important to optimal adolescent health is adequate sleep, associated with increased physical activity and psychological well-being. Meanwhile, insufficient sleep has been linked to diabetes and compromised mental health problems. However, >57 % of middle schoolers and 72.7 % of high schoolers suffer from lack of sleep. Even with recent advances in sleep studies, less understood is the role of sleep and PCE in the context of ACEs. To fill this knowledge gap, we examined the link between ACEs (from 0-9 years) and adolescent subjective health (at 15 years) and tested the moderating/mediating role of PCEs and sleep within this association.

Methods: Multi-wave data came from the Fragile Families and Child Well-being Study (N=4,898) with a racially diverse and gender-balanced sample. Adolescent self-rated health (SRH) was based on youth’s self-rated perception of their health. ACEs measure is a sum of 11 adverse experiences (e.g., child abuse and neglect; peer violence) from birth to 9 years. PCE measure (latent) includes 13 indicators of positive experiences at home, school, and neighborhoods. Sleep quality was based on days in a week that youth had difficulty falling or staying asleep. We used Pearson and Point-Biserial correlations to examine bivariate associations. Confirmatory factor analysis was used to evaluate the measurement model. Structural equation modeling was used to test the conceptual model using X2, RMSEA, CFI, and TLI to assess fit.

Results: Results indicate satisfactory fit of the measurement and structural models to the data and support the hypothesized associations between study variables and the mediating role of PCE and sleep quality. We found evidence of the negative association between ACEs and SRH and between ACEs and PCEs, where a higher ACEs score was associated with diminished PCEs (b = -.19; p = .001). A similar association was observed from PCE to sleep problems and SRH, where higher PCE score was associated with less sleep problems (b = -.448; p = .001) and better SRH (b = .246; p = .001). Results supported the expected indirect effects of ACEs on SRH through PCEs and sleep problems, indicating the significant mediating role of PCEs and sleep problems.

Discussion/Implications: Our findings highlight the importance of positive experiences and sleep in offsetting some of the damaging effects of adversity on health. Evidence presented demonstrates that youth can have positive experiences that can be as consequential to their health as adverse experiences. Findings regarding sleep as a mediator indicate that sleep health could be a promising target of interventions that aim to strengthen developmental foundations crucial to lifelong health. Increasing access to opportunities and resources that foster positive experiences is critical, especially for black, indigenous, and youth, and families of color who are disproportionately impacted by structural and systemic inequities, factors known to have adverse effects on health.