The Effects of Direct and Environmental Adverse Childhood Experiences on Risk Behaviors and Health Outcomes in Utah Adults *

BACKGROUND:   Adverse Childhood Experiences (ACEs) are associated with risk behaviors and health outcomes in adulthood. We looked at the adjusted effects of direct and environmental ACEs on tobacco and alcohol use as well as selected health outcomes. Analysis of state-level ACE data can inform public health and behavioral health efforts.

METHODS:   We analyzed data from 5801 randomly selected adult respondents in Utah’s 2013 Behavioral Risk Factor Surveillance System. 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, incarceration, or witnessing abuse among household adults. We estimated the odds-ratios of direct and environmental ACEs on tobacco and alcohol use, as well as obesity, fair/poor health, and depression adjusting for sex, age, and education level.

RESULTS:   The prevalence by ACE type was as follows: direct ACEs, 14.8% (CI: 13.7%-16.0%); environmental ACE, 19.2% (CI: 17.8%-20.6%); both direct and environmental ACEs, 29.1% (CI: 27.6%-30.8%). The adjusted effect of direct ACEs was not significant for current smoking (OR=1.3, p=.18), binge drinking (OR=1.2, p=.32), and chronic drinking (OR=.80, p=.47). The adjusted effect of direct ACEs was significant for fair or poor health status (OR=1.4, p=.02), lifetime depression (OR=1.6, p<.01), and obesity (OR=1.3, p=.03). The adjusted effect of environmental ACEs was significant for current smoking (OR=2.1, p<.01), and binge drinking (OR=1.8, p<.01), but not chronic drinking (OR=1.6, p=.07) and the adjusted effect of environmental ACEs was significant for fair or poor health status (OR=1.5, p=.02), lifetime depression (OR=1.7, p<.01), but not for obesity (OR=1.1, p=.68). Respondents who reported both direct and environmental ACEs had greater odds of current smoking (OR=3.3, p<.01), binge drinking (OR=2.3, p<.01), chronic drinking (OR=2.2, p<.01), fair or poor health status (OR=2.4, p<.01), lifetime depression (OR=4.3, p<.01), and obesity (OR=1.7, p<.01).

CONCLUSIONS:   Nearly half of Utah’s adult population reported experiencing direct and/or environmental ACEs. Direct ACEs did not have an effect on adults’ use of tobacco and alcohol but did have significant effect on fair or poor health status, depression and obesity. Environmental ACEs were positively associated with all risk behaviors and health outcomes except chronic drinking and obesity. Having both direct and environmental ACEs increased the odds of all adverse health outcomes.  Behavioral health interventions may help children growing up in unhealthy household environments resist the use of addictive and abusive substances. Treatment of chronic diseases might benefit from screening for depression or other mental health disorders.