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METHODS: We analyzed data from 9,262 randomly selected respondents who completed the state-added optional ACE module for Nebraska’s 2011 Behavioral Risk Factor Surveillance System, a telephone survey of a representative sample of noninstitutionalized adults. Direct ACEs were defined as reported childhood exposure to physical, sexual, or verbal abuse. Environmental ACEs were defined as reported childhood household exposure to mental illness, substance abuse, divorce, or incarceration, or witnessing abuse among household adults. We estimated ACE prevalence, accounting for complex survey design, and adjusted relative risk (aRR) of current tobacco use (lifetime use of ≥100 cigarettes, currently smoking “some days”) and obesity (body mass index ≥30) by ACE status by using logistic regression with predicted margins, controlling for age, sex, and education.
RESULTS: Prevalence of direct and environmental ACEs was 32.2% (95% confidence interval [CI]: 30.5%−34.0%) and 44.1% (95% CI: 42.2%−46.0%), respectively; 53% (95% CI: 51.1%−54.9%) experienced ≥1 ACE. Direct and environmental ACEs were both associated with current tobacco use (aRR: 1.7; 95% CI: 1.4−2.0 and aRR: 2.1; 95% CI: 1.8−2.5) and obesity (aRR: 1.2; 95% CI: 1.03−1.3 and aRR: 1.2; 95% CI: 1.05−1.3), respectively. A dose-response relation existed between total number of individual ACEs per person and both outcomes.
CONCLUSIONS: ACEs are common and associated with disease risk factors among Nebraska adults. Strategies to identify children experiencing ACEs and provide effective interventions during childhood might reduce smoking and obesity in adulthood.