Cumulative Adverse Childhood Experiences Research Articles

Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth.

Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.

Recovery from substance use disorder among adolescents: Roles of adverse and positive childhood experiences

AbstractThis study examines the roles of positive childhood experiences (PCEs) and adverse childhood experiences (ACEs) on the recovery from substance use disorder (SUD) among adolescents ages 12–17, utilizing data from the 2016–2019 National Survey of Children's Health (NSCH). On a sample of 256 adolescents who have had SUD, a hierarchical binary logistic regression analysis demonstrated that the cumulative PCEs significantly increased the odds of SUD recovery, whereas the cumulative ACEs did not decrease the odds.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe.

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Self-Reported Adverse Childhood Experiences and Risk for Internalizing and Externalizing Difficulties among Adolescent Custodial Grandchildren

Despite custodial grandchildren’s (CG) traumatic histories and risk for psychological difficulties, knowledge is scant regarding the frequencies, types, and consequences of adverse childhood experiences (ACEs) they have encountered. We examined self-reported ACEs via online surveys with 342 CG (ages 12 to 18) who were recruited to participate in an RCT of a social intelligence training program. ACEs were assessed by 14 widely used items, and risk for internalizing (ID) and externalizing (ED) difficulties were measured using 80th percentile cut-offs on the Strengths and Difficulties Questionnaire. Classification and regression tree analyses included all 14 ACEs (along with CG gender and age) as predictors of ID and ED risk separately. Given possible comorbidity, analyses were run with and without the other risk type as a predictor. Less than 9% of CG self-reported no ACEs, 48.6% reported two to five ACEs, and 30.5% reported ≥6. Irrespective of ED risk, bullying from peers strongly predicted ID risk. ED risk was peak among CG who also had risk for ID. Without ID risk as a predictor, ED risk was highest among CG who were emotionally abused, not lived with a substance abuser, and encountered neighborhood violence. The frequency and types of ACEs observed were alarmingly higher than those among the general population, suggesting that many CG have histories of trauma and household dysfunction. That a small number of ACEs among the 14 studied here were significant predictors of ID and ED risk challenges the widespread belief of a cumulative dose ACE effect.

174. Adolescent Mental Health Problems Partially Mediate Association Between Cumulative Adverse Childhood Experiences and High School Dropout: A Path Analysis

174. Adolescent Mental Health Problems Partially Mediate Association Between Cumulative Adverse Childhood Experiences and High School Dropout: A Path Analysis

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

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.

Predicting comorbid mental health difficulties in people with autoimmune arthritis.

Little is known about variables impacting the association between mental health difficulties and autoimmune conditions. This study investigates whether, age of onset, adverse childhood experiences (ACEs), and 'illness invisibility' predict comorbid mental health difficulties in people with autoimmune arthritis. Participants with autoimmune arthritis (N = 209) were recruited via social media platforms. Age of onset of arthritis and the temporal order of mental health difficulties (if applicable) were collected alongside a measure of personality and ACEs. A novel measure of illness invisibility was developed for this study. A cross-sectional mixed-subject design was utilised. 53.5% of the sample endorsed lifetime mental health difficulties. Logistic regression analyses revealed participants with a younger age of onset of arthritis had significantly higher odds of developing a mental health problem (OR 0.93, 95% CI 0.90-0.96). Independently, Illness Invisibility, endorsed by 89.9% of participants, significantly predicted postmorbid mental health difficulties (OR 1.08, 95% CI 1.01-1.19). Adverse Childhood Experiences were frequently endorsed within the sample with 37.8% reporting ≥ 3 cumulative ACEs. Every unit increase in ACEs increased the odds of having comorbid mental health difficulties (OR 1.27, 95% CI 1.09-1.47). Young people who are diagnosed with autoimmune arthritis maybe more likely to experience subsequent mental health difficulties. The 'invisibility' of their illness and exposure to ACEs also is associated with their risk for mental health complications. These findings highlight the importance of mental health screening for young people being investigated for arthritis and interdisciplinary care, especially for young people.

Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity.

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR=1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI: 0.78-0.91). Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

The association between adverse childhood experiences and sensory impairment in middle-aged and older adults: Evidence from a nationwide cohort study in China

BackgroundSensory impairment (SI), as prevalent condition among the elderly, presents a substantial public health burden. ObjectivesTo investigate the association of cumulative and individual adverse childhood experiences (ACEs) with SI. MethodsChinese residents aged 45 years and above were recruited from the China Health and Retirement Longitudinal Study 2011–2018, using stratified random sampling. The number of ACEs was classified into “0 ACE”, “1 to 3 ACEs”, and “≥4 ACEs”. SI was assessed with self-rated visual or hearing status. SI categories included single sensory impairment (SSI), which can be divided into single vision impairment and single hearing impairment. Possessing both vision impairment and hearing impairment was considered as dual sensory impairment (DSI). Longitudinal SI progression encompassed “maintained no SI”, “no SI to SSI”, “no SI to DSI”, “maintained SSI”, “SSI to DSI”, and “maintained DSI”. Logistic regression and restricted cubic splines models were used for analysis. ResultsA total of 6812 participants entered the cross-sectional analysis and 5299 entered the longitudinal analysis. Compared to 0 ACE, ≥4 ACEs had a positive association with DSI (OR = 1.57, 95 % CI = 1.20–2.06) but not with single vision impairment (OR = 1.17, 95 % CI: 0.88–1.55) or single hearing impairment (OR = 1.10, 95 % CI: 0.71–1.70), and this association was observed only in females (OR = 1.73, 95 % CI = 1.20–2.51). A linear association was found between cumulative ACEs and both single vision impairment (p = 0.044) and DSI (p < 0.001). Compared to 0 ACE, ≥4 ACEs was associated with a higher risk of progression from SSI to DSI (OR = 1.71, 95 % CI = 1.03–2.84), and the maintained DSI (OR = 2.23, 95 % CI =1.37–3.65). ConclusionACEs were found to be associated with an increased risk and more severe progression of SI later in life. It is imperative to address different types of ACE and incorporate sex-specific measures to mitigate the enduring sensory impact of ACEs.

Adverse Childhood Experiences and Bullying During Adolescence: A Systematic Literature Review of Two Decades

AbstractThere is a need for a comprehensive understanding of the relationship between adverse childhood experiences (ACEs) and the emergence of bullying behaviors in adolescence, as well as their subsequent implications for youth well-being. This study systematically reviewed the link between 11 unique ACEs (including the original 10 from the 1998 CDC-Kaiser ACE study plus child welfare involvement) and three specific bullying behaviors (i.e., perpetration, victimization, and bully-victim) over two decades (1999–2019). Five databases (i.e., Embase, ERIC, PsycINFO, PTSDpubs, and PubMed) were used to identify 51 studies. The findings showed a consistent pattern of positive associations for certain ACEs, specifically cumulative ACEs, maltreatment, family violence, physical abuse, and domestic violence, with bullying perpetration and victimization. However, sexual abuse and divorce and separation were not consistently related to perpetration or victimization. In addition, general abuse was positively associated with perpetration, whereas emotional abuse and children in the welfare system tended to be victims rather than perpetrators of bullying. Notably, several ACEs, including neglect and household dysfunction, remain largely understudied in relation to bullying. The research also predominantly focuses on bullying perpetration and victimization, with bully-victims receiving much less attention. Finally, the research on the impact of bullying behaviors on the well-being of youth with ACEs is too limited to make definitive conclusions regarding the mediating or moderating role of bullying on youth well-being outcomes. The results underscore the importance of understanding and accounting for the simultaneous and cumulative effects of ACEs. This understanding is essential when designing trauma-informed interventions and prevention strategies to combat bullying. Future longitudinal studies should rectify methodological and psychometric shortcomings, investigate potential mediators and moderators, and integrate health outcomes of positive experiences with adverse childhood experiences to capture shared risk and resilience pathways.

The Association Between Adverse Childhood Experiences (ACEs), Bullying Victimization, and Internalizing and Externalizing Problems Among Early Adolescents: Examining Cumulative and Interactive Associations

Both adverse childhood experiences (ACEs) and bullying victimization are linked with mental health problems in adolescents. However, little is known about the overlap between the two factors and how this impacts adolescent mental health problems (i.e., internalizing and externalizing problems). The current study analyzed data from 8,085 participants (47.7% female; 44.1% racial/ethnic minority) in the Adolescent Brain Cognitive Development (ABCD) study, baseline (2016–2018, ages 9–10 years) to Year 2. Regression analyses were used to estimate associations between ACEs, bullying victimization and mental health problems, respectively, adjusting for sex, race/ethnicity, country of birth, household income, parental education, and study site. The findings showed that both ACEs and bullying victimization were independently associated with higher internalizing and higher externalizing problems. However, no significant interaction was found between ACEs and bullying victimization. Overall, the results align with the cumulative risk model of adversity, linking cumulative ACEs and bullying victimization to internalizing and externalizing problems in early adolescents.

Associations between COVID-19-related family hardships/distress and children's Adverse Childhood Experiences during the pandemic: The Environmental influences on Child Health Outcomes (ECHO) program

BackgroundEconomic hardships imposed by the pandemic could have implications for children's experiences of adversity in the home, or Adverse Childhood Experiences (ACEs). ObjectiveThis observational cohort study examined associations between COVID-19-related hardships and distress (e.g., job loss, caregiver stress) and the cumulative number of child ACEs reported by caregivers during the pandemic (i.e., March 1, 2020–February 28, 2022). Participants and settingThe study included children (N = 4345; median age = 6.0 years, interquartile range = 4–9 years) and their parents/caregivers who participated in the NIH-funded Environmental influences in Child Health Outcomes (ECHO) Program. MethodsWe described socio-demographic characteristics and pandemic-related family hardships/distress and cumulative child ACE scores reported during pre-pandemic and pandemic periods. We used negative binomial regression models to evaluate associations between pandemic-related family hardships and cumulative child ACE scores reported during the pandemic. ResultsEach caregiver-reported hardship/distress was associated with higher child ACE scores reported during the pandemic. After accounting for pre-pandemic child ACE scores, moderate and severe symptoms of pandemic-related traumatic stress among caregivers were associated with 108 % and 141 % higher child ACE scores reported during the pandemic, respectively, compared with no or low caregiver symptoms. In addition, finance-related stress during the pandemic was associated with 47 % higher child ACE scores. After adjusting for pre-pandemic child experiences of neglect, most sources of stress remained significantly associated with higher child ACE scores reported during the pandemic, particularly severe/very severe symptoms of pandemic-related traumatic stress among caregivers. Findings held for children with no known pre-pandemic ACEs. ConclusionsThis research suggests that caregivers experiencing financial hardships and those with severe pandemic-related traumatic stress may require additional support systems during stressful events.

Adverse childhood experiences and adolescent handgun carrying

PurposeConsiderable research has shown that adverse childhood experiences (ACEs) are associated with well-known correlates of handgun carrying, such as delinquent peer association, substance use, and police contact and/or arrest. Yet, little to no research to date has explicitly examined the potential role of ACEs in adolescent handgun carrying. The current study examines this important gap in existing literature. MethodsData drawn from the 2022 Florida Youth Substance Abuse Survey (FYSAS, n = 23,078), a statewide representative sample of Florida high School students, were analyzed to examine the associations between individual ACEs and cumulative ACEs and carrying a handgun in the past 12 months. ResultsExposure to ACEs, such as family incarceration, family violence, and parental separation/divorce increased the likelihood of carrying a handgun three or more times in the past 12 months. Moreover, a dose-response relationship was identified between ACEs and handgun carrying, wherein, the more ACEs an adolescent was exposed to, the more likely they were to have carried a handgun in the past 12 months. ConclusionsThis study highlights the contribution of ACEs to adolescent handgun carrying behaviors.

Association between adverse childhood experience and unintended pregnancy among Japanese women: a large-scale cross-sectional study

Unintended pregnancy (UP) can negatively impact the health of mothers, children, and families. While Adverse Childhood Experiences (ACEs) are increasingly known to affect sexual health, the influence on pregnancy intention is not fully understood. This study examines the relationship between ACEs and UP and explores other related factors, using 5049 pregnant and postpartum women data from the Japan COVID-19 and Society Internet Survey (JACSIS). We measured participants’ pregnancy intentions, ACEs, family functioning, and social network size. Logistic regression analysis provided odds ratios and 95% confidence intervals (CI). The prevalence of UP was approximately 16.5% (n = 893). Cumulative ACEs were consistently associated with UP, even after adjusting for intermediate variables in adulthood. The odds ratio for UP with a single ACE was 1.00 (CI: 0.82–1.21) but rose significantly with multiple ACEs: 1.39 (CI: 1.10–1.76) with double, 1.38 (CI: 1.02–2.86) with triple, and 1.81 (CI: 1.37–2.39) with more. Additionally, bad family functioning and lack of social networks emerged as contributors to UP. In conclusion, this study showed that ACEs are potentially correlated with UP. A deeper understanding of the transition from childhood experiences to UP is important for health interventions, necessitating further investigation.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

This study compared the prevalence of adverse childhood experiences (ACEs) across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate ACE prevalence estimates. Unadjusted one-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative ACE measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted to estimate ACE scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Compared to straight participants, adolescents with same-sex attractions and adults who identified with a sexual minority group reported more ACEs overall, though associations varied by ACE type. Strikingly, ACE scores were higher among White than Black youth with same-sex attractions, more economically advantaged than poor bisexual adults, and poor White than poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A MAIHDA interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative ACE scores whereas gender and race/ethnicity did not. The results show that ACE disparities can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that ACEs are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

The effect of adverse childhood experiences on family mealtime frequency: Examining racial and ethnic differences.

Eating meals as a family is associated with multiple positive nutritional and emotional outcomes for parents and children. Although the benefits of mealtimes extend to all families, families of color and those in poverty face disproportional barriers to eating frequent meals together. No previous study has properly attended to the heterogeneity of racial and ethnic groups in the United States when assessing mealtime barriers. Focusing on adverse childhood experiences (ACEs), our analyses tested whether an increased number of adversities, and particular types of adversities, were associated with a decrease in mealtime frequency for different racial/ethnic families in the United States. Utilizing a large, nationally representative sample of families (n = 59,963), results showed that higher cumulative ACE scores reduced the number of days a family eats meals together in a given week. For specific ACE items, seven out of nine individual ACE items were associated with decreased mealtimes (excluding parental death and racial discrimination). Stratification resulted in varied associations between accumulated and individual ACE items and mealtime frequency depending on racial/ethnic group. Asian families in particular had greater odds of infrequent meals than other families, while Native American, Alaskan Native, Pacific Islander, and other racial/ethnic families were unaffected by increased ACEs. Results indicate that a family's accumulation of multiple adversities may impede mealtimes by either forcing families to prioritize the management of other stressors or by depleting the physical and mental resources needed to establish a routine. Focusing on family cultural traditions as protective factors may be an area of future intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improving the Way that We Conceptualise Adverse Childhood Experiences - A Commentary on Sisitsky et al. (2023).

Research on adverse childhood experiences (ACEs) has traditionally relied on cumulative ACE scores, which prevents understanding about the effects of distinct adversities and their mechanistic pathways. Dimensional and person-centred approaches have been proposed as alternative methods to conceptualise ACEs, which address limitations of the cumulative ACE score. In this issue, Sisitsky et al. (Research on Child and Adolescent Psychopathology, 2023)apply these approaches to identify dimensions of ACEs and profiles of children with distinct patterns of early exposure, in a large, racially diverse cohort from the US. The authors also examine the longitudinal associations between profiles of early adversity in early childhood with later mental health and telomere length. In this commentary, we discuss key findings from the study and recommend future avenues for improving the conceptualisation of ACEs.

Positive Early Childhood Experiences and School Readiness among US Preschoolers

To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). We analyzed national data on children ages 3-5 from 2016 to 2020 (n=26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study

ObjectivesAdverse childhood experiences are potentially traumatic events that occur up to age 17, including abuse, neglect, and household dysfunction. Such trauma often results in chronic stress and poor sleep health, which are linked to negative health outcomes across the lifespan. This study examines the longitudinal association between adverse childhood experiences (ACEs) and insomnia symptoms from adolescence to adulthood. MethodsData from the National Longitudinal Study of Adolescent to Adult Health were used to examine the association between ACEs and insomnia symptoms (trouble falling asleep or staying asleep, dichotomized based on self-reported frequency of 3 times per week or more). We used weighted logistic regression to examine the association between cumulative ACE score (0, 1, 2-3, 4+), 10 specific ACEs, and insomnia symptoms. ResultsOf 12,039 participants, 75.3% experienced at least one adverse childhood experience and 14.7% experienced 4 or more. We found specific adverse childhood experiences, including physical abuse, emotional abuse, neglect, parental incarceration, parental alcoholism, foster home placement, and community violence were associated with experiencing insomnia symptoms throughout the entire 22-year follow-up period from adolescence to mid-adulthood (p < .05), while childhood poverty was only associated with insomnia symptoms in mid-adulthood. The number of adverse childhood experiences showed a dose-response association with insomnia symptoms in adolescence (1 adverse childhood experience: adjusted odds ratio (aOR)=1.47 [1.16, 1.87], 4+ adverse childhood experiences: aOR= 2.76, [2.18, 3.50]), early adulthood (1 adverse childhood experience: aOR= 1.43 [1.16, 1.75], 4+ adverse childhood experiences: aOR= 3.07 [2.47, 3.83]) and mid-adulthood (1 adverse childhood experience: aOR= 1.13 [0.94, 1.37], 4+ adverse childhood experiences: aOR= 1.89 [confidence interval: 1.53, 2.32]). ConclusionsAdverse childhood experiences are associated with an increased risk for insomnia symptoms across the lifespan.

Adverse childhood experiences and clustering of high-risk behaviors among high school students: a cross-sectional study

ObjectivesThis study assessed the association between adverse childhood experiences (ACEs) and clustering of high-risk behaviors in a sample of high school students. Study designThis was a cross-sectional study. MethodsA sample of students who attended randomly selected classes in 99 high schools completed the 2019 Nevada Youth Risk Behavior Survey (N = 4959). The survey included six ACE measures: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) household physical abuse, (5) household mental illness, and (6) household substance abuse. Students were assigned a cumulative ACE score (range = 0–6). A count of high-risk behavior domains was created using multiple questions across the following domains: (1) violence behaviors, (2) suicidal indicators, (3) non-suicidal self-injury, (4) substance use, (5) high-risk sexual behaviors, (6) poor diet, (7) physical inactivity, and (8) high screen time (range = 0–8). The relationship between ACEs and the count of high-risk behavior domains was assessed using weighted negative binomial regression; incidence rate ratios (IRRs) were calculated adjusting for sociodemographic characteristics. ResultsMore than 40% of the sampled students reported high-risk behaviors across two or more domains. There was a strong, graded relationship between cumulative ACE score and the count of high-risk behavior domains. Compared with students who experienced zero ACEs, there was an increase in the count of high-risk behavior domains among students who experienced one ACE (adjusted IRR [aIRR] = 1.22, 95% confidence interval [CI] = 1.12–1.33), two ACEs (aIRR = 1.57, 95% CI = 1.42–1.73), three ACEs (aIRR = 1.73, 95% CI = 1.54–1.94), four ACEs (aIRR = 2.07, 95% CI = 1.84–2.33), five ACEs (aIRR = 2.69, 95% CI = 2.34–3.10), and six ACEs (aIRR = 2.91, 95% CI = 2.34–3.62). ConclusionTrauma-informed prevention efforts may be an efficient way to address multiple adolescent risk behaviors that cluster.