231 - The Impact of Positive Childhood Experiences on Adult Health and Socioeconomic Outcomes: Examining Adverse Childhood Experiences as a Moderator

Publication Number: 2222.231

Kelsey Hannan, Tufts University School of Medicine, Boston, MA, United States; Dina Burstein, Tufts University School of Medicine, Boston, MA, United States; Robert Sege, Tufts University School of Medicine, boston, MA, United States

Background: Both positive childhood experiences (PCEs) and adverse childhood experiences (ACEs) play an influential role in adult well-being. PCEs have been shown to protect physical, behavioral, and mental health, while ACEs have been linked to long-term negative outcomes. Less is known about how ACEs may reduce the beneficial impacts of PCEs.

Objective: The objective of this study was to investigate the associations between PCEs and adult health and socioeconomic outcomes and determine whether ACEs moderate these relationships.

Design/Methods: We analyzed data from 18,773 adult respondents of the Behavioral Risk Factor Surveillance Survey (BRFSS) in four states (Kansas, Michigan, South Carolina, and Wisconsin; 2015-2020). PCEs and ACEs were categorized and evaluated against 20 adult health and life opportunity outcomes. Propensity score matching and survey-weighted generalized linear models were used to estimate population-level metrics, including adjusted prevalence ratios (aPRs), population attributable fractions (PAFs), and prevented fractions for the population (PFPs).

Results: PCEs and ACEs exhibited an inverse relationship: 73.02% of adults with 0 ACEs had high (6-7) PCEs; 55.32% of adults with 1-3 ACEs had high PCEs; and 26.37% of adults with 4+ ACEs had high PCEs. Even after adjusting for covariates, the probability of reporting four or more ACEs was 10 times higher than reporting 0 ACEs for those with low (0-2) PCEs. Higher PCEs were associated with improved outcomes, including reduced depression, better mental health, and increased income and education, regardless of ACE exposure. Among those reporting any ACEs, high PCEs were associated with lower cigarette smoking, lower prevalence of several chronic diseases (asthma, diabetes, heart disease), and better general health. PFPs estimated that increasing PCEs could reduce depression prevalence by 36.5% and poor mental health by 30.7%.

Conclusion(s): PCEs strongly predicted better adult health and life opportunities, even in the presence of adversity. ACEs moderated some, but not all, of the associations, highlighting the independent protective value of PCEs. For other conditions, the protective value of PCEs was stronger for those who had experienced ACEs. These findings support the promotion of PCEs as a public health strategy to improve long-term health and socioeconomic outcomes.

Variation in positive childhood experiences and adverse childhood experiences among adults, Behavioral Risk Factor Surveillance System, Four states, 2015-2020
Abbreviations: CI=confidence interval; PCEs=positive childhood experiences; ACEs=adverse childhood experiences.
a Non-weighted number.
b After adjusting for state, sex, race/ethnicity, and age.
Statistical significance: *** p<0.01, ** p<0.05, * p<0.1

Population Attributable Fractions for Life Opportunities and Prevented Fractions for the Population for Health Risk Behaviors and Chronic Conditions Associated with Positive Childhood Experiences, Behavioral Risk Factor Surveillance System, Four States, 2015-2020
All results in this table are weighted.
For all results in this table, we first used propensity score methods to better isolate the exposure effect and to match respondents without PCEs exposure to persons with PCEs on socio-demographic factors unlikely affected by the exposure (i.e., sex, race/ethnicity, age, and state of residence).
a Adjusted for location (state) and demographic factors (sex, race/ethnicity, and age).
b Adjusted for location (state), demographic factors (sex, race/ethnicity, and age), and socio-economic factors. (college or income $50,000 or more).
c Estimates based on the data from three states: Kansas, Montana, and Wisconsin.
d Adjusted for location (state), demographic factors (sex, race/ethnicity, and age), socio-economic factors (college or income $50,000 or more), and any behavioral issues.
e Estimates based on the data from three states: Kansas, Montana, and South Carolina.
f PAFs by PCE/ACE exposure category were estimated for the outcome/exposure combinations with statistically significant (two-sided p<.05) associations by using Mittinenn's method appropriate for cross-sectional studies.