Abstract
BackgroundAdverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). This study aims to identify risk factors for ACEs and to examine the associations between ACEs and single and multiple HRBs in a sample of university students in Germany.MethodsAn online-based cross-sectional study was conducted among public university students (N = 1466). The widely applied ACE questionnaire was used and extended to operationalise 13 categories of childhood adversity. First, variables for each type of ACE and HRB were dichotomised (single ACEs and single HRBs), and then used for cumulative scores (multiple ACEs and multiple HRBs). Frequencies were assessed, and (multinomial) logistic regression analyses were performed.ResultsPrevalence rates of ACEs ranged from 3.9 to 34.0%, depending on the type of childhood adversity. Sociodemographic risk and protective factors for single/multiple ACEs varied strongly depending on the outcome. In particular, a high family socioeconomic status seemed to be a consistent protective factor for most ACEs. After adjusting for sociodemographic characteristics, both single and multiple HRBs were associated with single events of ACEs. Moreover, dose-response relationships between multiple ACEs and various single and multiple HRBs were found.ConclusionsThe study provides strong evidence that ACEs are associated with HRBs. The number of ACEs may play a role in single or multiple HRBs. Reducing the number of ACEs could thus decrease HRBs, which account for many of the leading causes of morbidity and death. The findings highlight the importance of trauma-informed health interventions designed to prevent the occurrence of ACEs, and build capacity among children and adults.
Highlights
Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs)
Since exposure to ACEs is rarely found to occur in isolation [23, 24], it is essential to understand that children experiencing multiple types of maltreatment have a greater vulnerability [25]
The cumulative ACE score shows that 22.9% (n = 348) of the students had experienced one ACE, 15.7% (n = 216) two ACEs, 9.0% (n = 135) three ACEs, and 24.6% (n = 355) four or more ACEs
Summary
Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). The occurrence of ACEs is the product of a complex interplay between multiple risk and protective factors. Following an ecological perspective [26], these key factors can appear at an individual level, in social relationships, in a community context, and in a societal layer increasing the risk of ACEs [27]. In addition to these adverse effects, protective factors (e.g., support from a trusted adult) can mitigate the risk of ACEs [28]
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