PMU7 ASSOCIATION OF ADVERSE CHILDHOOD EVENTS AND HEALTH OUTCOMES WITHIN THE BRFSS DATABASE IN PENNSYLVANIA

Abstract

Numerous studies have established the relationship between negative health outcomes and adverse childhood events (ACEs); however, the unique contribution of the ACEs vs. health behaviors on outcomes is difficult to distinguish. The purpose of this study is to assess the relationship between ACEs and chronic disease outcomes (CDs) while removing the influence of smoking. We conducted a cross-sectional study of adults in Pennsylvania using the 2014 Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFFS) survey. Self-reported ACEs were summed from eight survey questions to calculate the primary independent variable: ACE score. CDs included prior heart attack, current asthma, and self-reported health status. The association between ACEs and CDs, ACEs and smoking status, and ACEs and CDs adjusting for smoking were computed using multiple logistic regression. All models were covariate-adjusted. The analysis included a total of 9,241 adult respondents of whom 51% had at least one ACE and 6% had ≥ five ACEs. ACEs were significantly related to smoking. After adjusting for covariates only, individuals with ≥ five ACEs had statistically significantly increased odds of experiencing CDs [ORs of 2.06, 2.33, and 3.30, for heart disease, asthma, and poor self-rated health, respectively]. When adjusting for smoking status, there was evidence of mediation between ACEs and the CD outcomes by smoking [ORs of 1.79, 2.34, and 2.73 for heart disease, asthma, and poor self-rated health, respectively], but the relationships remained statistically significant. Individuals experiencing ≥ five ACEs were at higher odds of being diagnosed with CDs, even after controlling for smoking. Thus, we conclude that smoking mediated the relationship between ACEs and the CD outcomes. Future research should be conducted to further unpack the relationship between multiple health behaviors, ACEs and CDs.