Association of Adverse Childhood Experiences and Metabolic Syndrome: A Systematic Review and Meta-Analysis.

1.110 Marijuana Use in Adverse Childhood Experience (ACE)-Exposed Young Adults and the Mediating Effect of Family Environment

Background: Prior studies have reported a significant association between Adverse Childhood Experiences (ACEs) and various health outcomes, including cancer; however, these have been limited to descriptive and cross-sectional studies. These studies reported that resilience, or the ability to adapt to challenging life experiences, is inversely associated with ACEs and cancer history. To date, there are no studies evaluating the interaction of ACEs and a cancer diagnosis on resilience among adult survivors. The primary aim of this study is to estimate the prevalence of ACEs among RURAL Alabama participants and to determine if the presence of ≥ 4 ACEs and a cancer history influences the odds of reporting self-perceived low and medium (vs. high) resilience compared to those with 0-3 ACEs and no cancer history. Methods: We utilized data from Alabama participants of the RURAL (Risk Underlying Rural Areas Longitudinal) Cohort Study, a prospective study designed to evaluate risk factors for heart and lung disorders in four rural southeastern states. Individuals aged 25-64 years and residents of two counties in Alabama were enrolled and completed a baseline and 3-month follow-up survey. The 30-item Early Trauma Inventory was used to assess the prevalence of ACEs, and the 10-item Connor Davidson-10 Resilience Scale was used to measure self-perceived resilience. Participants were categorized as having high resilience if their total resilience score was ≥75th percentile, medium resilience for scores ≥25th and <75th percentile, and low resilience for scores <25th percentile. Weighted multinomial logistic regression models were used to evaluate the association between number of ACEs (0-3 ACEs vs. ≥ 4 ACEs) and resilience categories and tested interactions between ACEs and cancer history; a p-value <0.05 was considered statistically significant. Results: Of the 556 participants, 38.9% reported having 0-3 ACEs, and 61.1% reported ≥ 4 ACEs. In adjusted models among participants with no cancer history, those experiencing ≥ 4 ACEs had 2.38 times the odds of reporting low (vs. high) resilience (95% CI: 1.93, 2.94) and 1.18 times the odds of reporting medium (vs. high) resilience (95% CI: 1.04, 1.35) compared to those experiencing 0-3 ACEs. Among participants with a cancer history, those experiencing ≥ 4 ACEs had 1.82 times odds of reporting low (vs. high) resilience (95% CI: 1.01, 3.28) and 0.76 times odds of reporting medium (vs. high) resilience (95% CI: 0.49, 1.18) compared to those experiencing 0-3 ACEs. Interactions between ACEs and cancer history were not statistically significant for low and medium (vs. high) resilience (p-values: 0.4 and 0.06, respectively). Conclusion: Those with a cancer history and ≥ 4 ACEs were more likely to report self-perceived low resilience. Significant interactions between ACEs and cancer history were not observed in predicting low and medium resilience (vs. high). To better understand the cumulative effects of ACEs, it is necessary to longitudinally evaluate individuals’ ability to adapt, especially among cancer survivors. Citation Format: Stephie Abraham, Kathy B. Baumgartner, Richard Baumgartner, Jesse Hsu, Joanna Walsh, Mahasin S Mujahid, Viola Vaccarino, Stephanie Boone. The association of adverse childhood experiences (ACEs) and cancer history with resilience: Results from Alabama sites of the RURAL cohort study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C031.

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

The association between adverse childhood experiences (ACEs) and diabetes is unclear. This systematic review and meta-analysis aims to quantify the association between the number and types of ACEs and diabetes during adulthood based on available observational studies. A comprehensive literature search of studies exploring the association between ACEs and diabetes was conducted in PubMed, Medline, and Embase databases until 15 April 2022. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for the number and types of ACEs with diabetes. Regarding the association between the number of ACEs and diabetes, we used funnel plots to examine publication bias, subgroup analysis to explore sources of heterogeneity, and sensitivity analysis to explore the robustness of the pooled results. A total of 49 studies were included. Individuals with higher continuous ACEs (per each additional ACE: OR = 1.06, 95% CI = 1.02-1.10), any ACE (OR = 1.22, 95% CI = 1.16-1.28), or ≥4 ACEs (OR = 1.44, 95% CI = 1.27-1.63) were at an increased risk of diabetes in adulthood when compared with individuals without ACEs. Across specific ACE types, childhood economic adversity (OR = 1.11, 95% CI = 1.04-1.19), physical abuse (OR = 1.14, 95% CI = 1.07-1.21), sexual abuse (OR = 1.25, 95% CI = 1.12-1.39), verbal abuse (OR = 1.11, 95% CI = 1.03-1.20), and incarceration (OR = 1.22, 95% CI = 1.03-1.45) were associated with diabetes. However, neglect, emotional abuse, domestic violence, parental divorce or separation, parental death, and living with a family member with substance abuse or mental disorders were not significantly associated with diabetes. Individuals with ACEs may have a cumulative risk for diabetes in adulthood. It is critical to prevent ACEs and build resilience in individuals affected by ACEs.

Association of adverse childhood experiences with adult-onset cardiometabolic conditions and prescription medicine use Background and importance Adverse childhood experiences are potentially preventable and traumatic events that occur during childhood. Childhood exposure to trauma is highly prevalent and adults who had adverse childhood experiences are at increased risk of developing physical conditions. However, effect of adverse childhood experiences on health outcomes remains underrecognized. Aim Here, we aimed to measure the association of cumulative adverse childhood experience with adult physical condition and use of prescription medicines in general population. Methods We conducted a cross-sectional analysis using the population-based health study including 21083 participants at age 40 years or older. Self-reported adverse childhood experiences before age at 18 years, present or previous cardiometabolic conditions, and present or previous use of medications prescribed for cardiometabolic conditions were used in our analysis. Cox proportional hazards regression was used to estimate age, sex, smoking, education, and income-adjusted risk of cardiometabolic condition and prescription medicine use after adverse childhood experiences. Association of multimorbidity and using multiple prescription medicines with adverse childhood experience was analyzed using generalized linear model with ordinal classification. Results We found that having a history of adverse childhood experience was associated with increased risk of subsequent cardiometabolic conditions; hazard ratios ranged from 1.117 (95% CI, 1.054 – 1.185) to 1.341 (95% CI, 1.181 – 1.522). Furthermore, adverse childhood experience was associated with multimorbidity of cardiometabolic conditions (odds ratio [OR], 1.195; 95% CI, 1.117 – 1.279) and increased risk of using multiple prescription medicines (OR, 1.131; 95% CI, 1.057 – 1.210). Notably, we observed the dose – effect relationships of cumulative adverse childhood experience to the increased risk of 5 among 6 cardiometabolic conditions and to the increased risk of using 4 among 6 prescription medicines. Furthermore, cumulative adverse childhood experience had the dose – effect associations with multimorbidity of cardiometabolic conditions (ORs ranged from 1.120 [95% CI, 1.033 – 1.214] to 1.526 [95% CI, 1.276 – 1.825]) and using multiple prescription medicines (ORs are 1.393 [95% CI, 1.195 – 1.624] and 1.572 [95% CI 1.315 1.879]). Conclusions and relevance: Our findings implicate cumulative adverse childhood experience as a risk factor for later cardiometabolic conditions and use of medicines prescribed for cardiometabolic conditions. Our results are significant by suggesting inquiry into adverse childhood experience exposure during clinical consultations, services to alleviate the burden and increasing resilience in addition to strategies aimed at prevention of cardiometabolic conditions might improve health outcomes.

Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

This study aims to examine the association of adverse childhood experiences (ACE) with emotional and behavioral problems (EBP) among adolescents and the degree to which this association is stronger for more ACE. In addition, we assessed whether socioeconomic position (SEP) modifies the association of ACE with EBP. We obtained data from 341 adolescents aged 10–16 (mean age = 13.14 years; 44.0% boys), the baseline of a cohort study. We measured EBP with the strengths and difficulties questionnaire and socioeconomic position (SEP) with self-reported financial status. We used generalized linear models to analyze the association between ACE (0 vs. 1–2 vs. 3 and more) and EBP, and the modifying effect of SEP. Adolescents with 1–2 ACE (regression coefficient: 0.19; 95%-confidence interval (CI): 0.06–0.32) and with 3 ACE and over (0.35; 0.17–0.54) reported more overall problems compared with adolescents without ACE. Moreover, adolescents with 1–2 ACE (0.16; −0.01–0.32, and 0.16; 0.03–0.29) and with 3 and over ACE (0.33; 0.10–0.56, and 0.28; 0.09–0.47) reported more emotional problems and behavioral problems, respectively. The interactions of SEP with ACE were not significant. ACE are related to EBP among adolescents, with a clear dose-response association, and this association similarly holds for all SEP categories.

Traumatic and stressful events of childhood, known as adverse childhood experiences (ACEs), have been associated with numerous health outcomes. However, little is known about ACEs in atopic dermatitis (AD) patients. We sought to determine the relationship between ACEs and childhood AD. Data were analyzed from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study that followed 4898 women and their children born in large US cities. Multivariable weighted logistic regression models adjusting for sociodemographics were constructed to determine the associations of ACEs with AD prevalence at ages 5, 9, and 15 years. Children who experienced 1 ACE (multivariable logistic regression; adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.08-1.86), 2 ACEs (1.49; 95% CI, 1.10-2.02), or 3 or more ACEs (2.10; 95% CI, 1.52-2.89) had significantly increased odds of AD history compared with children without ACEs at age 5 years. Children who experienced 3 or more ACEs (1.48; 95% CI, 1.09-2.01) had significantly increased odds of AD history compared with children without ACEs at age 9 years. There were no significant associations between ACEs and history of AD at age 15 years. In conclusion, ACE exposures are related to childhood AD across time. Children who experience a greater number of ACEs have higher prevalence of AD.

BackgroundThe relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AAEs with incident CVD.MethodsThis prospective cohort study used data from the 2014 life course survey and the 2015 and 2018 surveys of the China Health and Retirement Longitudinal Study, a national survey of Chinese adults aged ≥ 45 years from 28 provinces across China. The study population included 5836 individuals (mean [SD] age, 59.59 [8.22] years, 49.7% were males). Information on ACEs, AAEs, young adulthood social support, health behavior factors, health status factors, and demographics was measured. Cox regression models, the difference method to estimate the mediation proportion, and the additive and multiplicative interactions were performed. Subgroup and sensitivity analyses were also conducted.ResultsDuring follow-up, 789 incident cases of CVD occurred. The fully adjusted model, including demographics, health behaviors, health status factors (e.g., depressive symptoms), and social support as control variables, demonstrated that the overall number of ACEs (Hazard ratio [HR]: 1.11, 95% CI: 1.08 to 1.14) and AAEs (HR: 1.19, 95% CI: 1.16 to 1.22) were associated with an increased risk of incident CVD. A dose–response relationship existed between the number of ACEs or AAEs and incident CVD risk. The overall AAEs were found to mediate 17.7% (95% CI: 8.2 to 34.2%) of the association between ACEs and incident CVD. Moreover, a significant additive interaction between ACEs and AAEs was detected (RERI [95% CI]: 0.32 [0.09 to 0.56]). Compared with adults without exposure to both ACE and AAE, those with exposure to both at least one ACE and one AAE indicator had the highest risk of incident CVD (HR: 1.96, 95% CI: 1.72 to 2.23).ConclusionsExposure to ACEs or AAEs was independently associated with an increased risk of incident CVD among Chinese middle-aged and older adults in a dose–response manner, and the overall AAEs partially mediated the association between ACEs and incident CVD. Preventive measures aimed at addressing either ACEs or AAEs alone may not significantly reduce the risk of CVD later in life. The necessity of a comprehensive life-course health strategy targeting the prevention of adversity merits increased attention.

Grit is important to experiencing success and is shaped through several childhood experiences. However, the association of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) to grit is underexplored, especially through emotional regulation. Hence, this study examined the association between ACEs, BCEs, emotional regulation, and grit. Further, we investigated the mediating role of emotional regulation between (a) ACEs and grit and (b) BCEs and grit. Self-report measures of ACEs, BCEs, emotional regulation, and grit were used to collect data from 548 Gen Z young adults born in 1997 or later (Female = 344, Male = 202, Mean age = 20.39) in India. We applied descriptive statistics, linear regression, and structural equation modelling (SEM) to analyze the data. The analyses revealed a significant negative association of ACEs with emotional regulation and grit, whereas BCEs were associated positively. Emotional regulation fully mediated the relationships between (a) ACEs and grit (β = -.08; CI = -.13 to -.04) and (b) BCEs and grit (β = .16; CI = .10 to .23). The study findings confirm the negative relationship of ACEs on an important life outcome, grit. However, BCEs showed beneficial effects. Furthermore, emotional regulation explains the association between negative and positive childhood experiences and grit. These findings have implications for fostering emotional regulation and mitigating the negative outcomes of ACEs among emerging adults.

The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and to explore a dose-response relationship between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional survey to assess adverse childhood experiences up to 1 year prior to the survey and SRB (suicide ideation and attempts) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with SRB as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friend and parental support, and the age at onset of cannabis and alcohol use. We included 7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The 6-month prevalence of suicidal ideation was 18.1% (95% confidence interval [CI]: 17.2%–19.0%), and the prevalence of suicide attempts was 5.0% (95% CI: 4.6–5.6). Among all adverse childhood experiences, only sexual abuse was a risk factor for both SRB. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p < .001) and on suicide attempts (p < .001). Additionally, ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. This is the first study exploring the influence of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America. HIGHLIGHTS Sexual abuse is associated with suicidal ideation and suicide attempts in 10th-grade secondary school students There is a dose-response effect between adverse childhood experiences and suicide-related behavior Ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively

Introduction Poor sleep has been shown to negatively impact cardiometabolic health. Adverse Childhood Experiences (ACEs), potentially traumatic events occurring within the first 18 years of life, have been linked to both poor sleep and cardiometabolic disease in adulthood. Evidence is needed to understand whether poor sleep plays a mechanistic role in the link between ACE exposure and cardiometabolic risk. The purpose of this study was to examine associations of ACE exposure with self-reported sleep efficiency (SE%) and waist circumference (WC). Methods In 25 young adults (21F/4M; mean±SD, age=25±5 y), we assessed ACE exposure using the 10-item ACE Questionnaire and SE% as the reported average sleep duration relative to time-in-bed from the Pittsburgh Sleep Quality Index. We measured WC, a known cardiometabolic risk factor, as a surrogate of visceral adiposity. We used multiple linear regression analyses to examine associations between ACE exposure, SE%, and WC adjusted for sex. We then utilized ANCOVA analyses to examine the possible mechanistic effect of SE% on the relationship between ACE exposure and WC. For these analyses, participants with 0-1 ACEs were categorized as low-ACE exposure (ACE-low) and participants with 2+ ACEs were categorized as moderate-to-high ACE exposure (ACE-mh). Results Following adjustment for sex, ACE score predicted SE% (β=-0.53, p=0.009) and WC (β=0.52, p=0.01), and SE% predicted WC (β=-0.44, p=0.03). Similarly, ANCOVA analyses indicated that ACE-mh was associated with greater WC than ACE-low, adjusted for sex (adjusted means ± 95% CI, 0.86 ± 0.07 m vs. 0.78±0.06 m; p=0.049). However, the effect of ACE group on WC was no longer significant following inclusion of SE% as a covariate (0.84 ± 0.07 m vs. 0.80 ± 0.07 m; p=0.29). Conclusion Both ACEs and sleep efficiency are associated with visceral adiposity. Further, SE% may serve as a mechanistic biobehavioral link between ACE exposure and increased visceral adiposity in young adults. These preliminary findings warrant further investigation with implications for sleep interventions as a possible preventative approach to reduce cardiometabolic risk in individuals exposed to ACEs. Support (if any) Research reported in this publication was partly supported by the NCATS of the NIH (UL1TR002537) and by the Injury Prevention Research Center through the CDC (R49 CE003095).

Association of adverse childhood experiences with diabetes: A systematic review and meta-analysis

Studies investigating the association of threat-related and deprivation-related adverse childhood experiences (ACEs) with later-life cognitive decline are lacking. To evaluate the independent association of threat-related and deprivation-related ACEs with cognitive decline over time among middle-aged and older Chinese adults and to examine the modifying role of social isolation in such associations. This prospective cohort study used cognitive data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey that was administered between June 1, 2011, and March 31, 2012, and the CHARLS follow-up survey administered between July 1 and September 30, 2015. The life history survey with information of ACEs was additionally administered between June 1 and December 31, 2014. Statistical analysis was performed from March 1 to July 31, 2022. The study population consisted of middle-aged and older adults (age range, 45-97 years) with complete data on ACEs and 2 cognitive assessments and without cognitive impairment at baseline. Five threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) before 17 years of age were queried by questionnaires. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. Cognitive function was measured by episodic memory and executive function. Global cognition was further calculated as the total score of these 2 dimensions. The raw scores of each cognitive test were standardized to z scores using baseline means and SDs. Linear mixed-effects models were constructed to examine the association between 2 dimensions of ACEs and the rate of annual cognitive decline. The modifying role of baseline social isolation in such associations was assessed with 3-way interaction tests. Of the 6466 participants included in main analyses, 3301 (51.1%) were men and the mean (SD) age was 57.2 (8.3) years. Compared with no exposures, experience of 1 deprivation-related ACE was associated with faster cognitive decline in global cognition (β = -0.012 [95% CI, -0.022 to -0.002] SD/y) and executive function (β = -0.010 [95% CI, -0.020 to -0.00002] SD/y), whereas individuals with at least 2 childhood deprivations had faster cognitive declines in all cognitive tests (β = -0.035 [95% CI, -0.050 to -0.019] SD/y for global cognition; β = -0.047 [95% CI, -0.068 to -0.025] SD/y for episodic memory; β = -0.019 [95% CI, -0.034 to -0.004] SD/y for executive function). However, such an association was not observed for threat-related ACEs. In addition, baseline social isolation was a significant modifier in the associations between deprivation-related ACEs and cognitive declines in global cognition (β = -0.033 [95% CI, -0.061 to -0.005] SD/y; P = .02 for 3-way interaction) and executive function (β = -0.032 [95% CI, -0.059 to -0.005] SD/y; P = .02 for 3-way interaction). Deprivation-related ACEs, but not threat-related ACEs, were associated with faster decline in later-life cognitive function, whereas social isolation could modify such detrimental impact. These findings highlight the potential benefits of promoting social integration in maintaining later-life cognitive function among individuals who have experienced childhood deprivation.

Community-level Adverse Experiences and Emotional Regulation in Children and Adolescents