Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples

Abstract

Introduction: Adverse childhood experiences (ACEs) are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences (ACEs), individually and in combination, confer health risk distinct from a cumulative adversity score. This study evaluates whether individual and comorbid ACE exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression. Methods: Cross-sectional analysis of ACE assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416). We modeled cumulative ACE scores and the 5 most common distinct ACE components that comprise a given ACE score, up to a cumulative score of 4. We compared ACE components, adjusted for covariates. Results: Across both samples 23% and 57-58% of persons reported 1 ACE or 2 or more ACEs, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero ACEs and 14.2% for persons reporting one ACE. When the single ACE was experiencing parental divorce, smoking was higher (16.6%) compared to when the single ACE was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 ACE, respectively, whereas it was 26.6% if the single ACE was living with a mentally ill household member and 11.0% when the ACE was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative ACE scores. Conclusions: Cumulative ACE scores mask substantial health risk heterogeneity which can be delineated by examining distinct components of cumulative ACE scores.