Adverse Childhood Experiences, Health Risk Behaviors and Chronic Health Conditions Among Kansas Adults: Results from the 2014 Kansas Behavioral Risk Factor Surveillance System

BACKGROUND: Longitudinal studies have demonstrated a link between adverse childhood experiences (ACEs) of abuse, neglect and family dysfunction and health status later in life. This may be explained in part by a toxic physiological stress response, such as elevated stress hormone levels, to multiple stressors, which may have damaging effects on a child’s developing brain. The Behavioral Risk Factor Surveillance System (BRFSS) introduced an optional module in 2008 to assess the relationship between ACEs and health status at the population-level. The ACE optional module was included for the first time in the Kansas BRFSS in 2014.  

METHODS: The ACE module is comprised of 11 questions that assess 8 categories of ACEs: childhood abuse, including physical, sexual and emotional abuse, and household dysfunction, including presence of a mentally ill household member, alcohol or drug abuse in the household, incarcerated household member, violence between adults in the household, and parental divorce or separation. Self-reported exposure to any single ACE category counted as one point toward the final ACE score (range: 0 to 8). SAS complex survey procedures were used to calculate overall and subpopulation prevalence estimates of each ACE category and ACE score. Prevalence estimates of various health risk behaviors and health conditions were also examined by ACE score.  

RESULTS: Emotional abuse, parental separation/divorce and substance abuse among a household member were the most common ACEs reported by Kansas adults. Nearly 1 in 3 (32.9%) Kansas adults reported experiencing emotional abuse, 1 in 4 (26.5%) reported their parents were separated or divorced, and 1 in 5 (21.8%) reported substance abuse by a household member. Approximately half (50.7%) of Kansas adults reported having experienced at least one ACE. The percentage of Kansas adults who experienced ≥3 ACEs was significantly higher among women, adults 18-64 years old, those with an annual household income less than $15,000, Hispanics and non-Hispanic other/multiracial adults. Current smoking, binge drinking, depression, poor mental health, poor physical health, current asthma and COPD were significantly higher among adults who experienced ≥3 ACEs compared with those who did not experience any ACEs. No significant differences were observed among ACE score subgroups for the prevalence of overweight/obesity, leisure time physical activity, diabetes, cancer, heart attack, stroke and kidney disease. 

CONCLUSIONS: Kansas data mirror findings in other states and highlight the need to increase awareness of ACEs as a public health issue. Preventing ACEs may have beneficial effects on the long-term health of Kansans.