Abstract
BackgroundMany studies have linked adverse childhood experiences (ACEs) to long-term health outcomes, as well as health risk behaviors. In the post-war period in Bosnia and Herzegovina, many young people grew up in an environment of deteriorated living standards due to high unemployment and economic insecurity. The objectives of the study were to: 1) describe the health risk behaviors of young adults accessing primary healthcare; and 2) examine associations of these risk factors with adverse childhood experiences in this context.MethodsThis was a cross-sectional survey, conducted from April to October 2014. Participants were recruited from the Primary Healthcare Center Zenica. Patients between the ages of 18 and 24 were eligible for inclusion. The informed consent and self-administered questionnaire were offered to patients during clinic intake. The questionnaire contained questions on sexual and reproductive health, use of alcohol and drugs, dating violence, and adverse childhood experiences.ResultsDuring the study period 520 questionnaires were distributed, and 400 complete surveys were returned, for a response rate of 76.9%. Among the 400 respondents, 166 were males (41.5%) and 234 were females (58.5%). Our study showed that 48.7% of respondents had experienced some form of childhood adversity. Emotional neglect was the most common type of adverse childhood experience (25.6%) and was significantly more prevalent among females. Our study indicated that more than 15% of respondents had witnessed domestic violence. Overall, ACEs were associated with increased odds of early sex initiation, alcohol use, drug use, and dating violence, although some of these associations did not reach statistical significance. Emotional neglect was the exception, and reporting emotional neglect was associated with a significantly elevated odds ratio for all four of the health risk behaviors. Emotional abuse was associated with an increased odds of drug abuse (OR = 2.78; 95% CI = 1.31–5.90) and dating violence (OR = 2.31; 95% CI = 1.10–4.89). Sexual abuse was marginally associated with increased early sex initiation (OR = 3.2; 95% CI 0.93–10.8). Parental divorce was significantly associated with alcohol abuse.ConclusionThe results of this study demonstrated associations between adverse experiences in childhood and the probability of engaging in health risk behavior which has implications for health outcomes in the long-term.
Highlights
Every year throughout the world, millions of children are victims of adverse experiences that create toxic stress, including non-fatal abuse and neglect [1]
Adverse Childhood Experiences (ACEs) were associated with increased odds of early sex initiation, alcohol
ACEs were associated with increased odds of early sex initiation, alcohol use, drug use, and dating violence, few of these associations were statistically significant
Summary
Every year throughout the world, millions of children are victims of adverse experiences that create toxic stress, including non-fatal abuse and neglect [1]. One of the first studies linking Adverse Childhood Experiences (ACEs) to premature death was conducted by a large healthcare provider in San Diego, California [2]. Since many studies have linked ACEs to long-term health outcomes including ischemic heart disease, cancer, chronic lung disease, suicide, and skeletal fractures as well as health risk behaviors such as substance use and smoking [3,4,5,6,7,8,9,10,11]. Many studies have linked adverse childhood experiences (ACEs) to long-term health outcomes, as well as health risk behaviors. The objectives of the study were to: 1) describe the health risk behaviors of young adults accessing primary healthcare; and 2) examine associations of these risk factors with adverse childhood experiences in this context
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