Abstract
BackgroundDespite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.MethodsData were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.ResultsThe study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16–3.25 among parents and 1.12–8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.ConclusionsFindings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).
Highlights
Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how Adverse childhood experiences (ACEs) are defined and conceptualized
Based on the findings from the current study, it is recommended that the ACEs list should be expanded from 10 ACEs to 16 ACEs in two categories as follows: 1) child maltreatment and peer victimization ACEs, including physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure Intimate partner violence (IPV), spanking, and peer victimization, and 2) household challenges, including household substance use, household mental health problems, household gambling problems, parental separation or divorce, parental problems with police, foster care placement or Child Protective Organization (CPO) contact, poverty, and neighborhood safety
The current findings show that all individual ACEs are related to poor mental and/or physical health indicators, but the effect sizes differ
Summary
Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. In 1998, Felitti and colleagues published the first research article using Wave I data from the original ACEs Study, which included eight ACEs: emotional abuse, physical abuse, sexual abuse, household member with substance use problems, household member with mental illness, mother treated violently, household criminal behavior, and parental separation or divorce [1, 2]. There has been no theoretical or empirical evidence published to indicate why 10 specific experiences were chosen as ACEs in the original ACEs Study data collection These 10 ACEs have been theoretically group together and typically conceptualized into two constructs: 1) child maltreatment ACEs, including physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect, and 2) household challenges or dysfunctions, including parental divorce, mother treated violently or exposure to intimate partner violence (IPV), household member with substance use problems, household member with mental health problems, and household member incarceration [1, 2]
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