title: Adverse Childhood Experiences, Military Service, and Adult Health.
abstract: BACKGROUND
  Prevalence of adverse childhood experiences (ACE) and associations with adult health may vary by gender and military service. This study compares the gender-specific prevalence of ACE by military service and determines the associations of ACE with adult health risk factors and health-related quality of life (HRQOL).
  
  
  METHODS
  This 2014 analysis used data from the 2011 and 2012 CDC Behavioral Risk Factor Surveillance System. Total ACE was operationalized as the number of reported ACE. Associations of total ACE with adult health risk factors were estimated using general linear models; associations with HRQOL were estimated using negative binomial regression. All analyses adjusted for age and race/ethnicity.
  
  
  RESULTS
  Those with military service had more total ACE than civilians. Higher ACE was associated with poorer HRQOL among women (physical health, military service, relative risk [RR]=1.20, 95% CI=1.09, 1.33; civilians, RR=1.18, 95% CI=1.17, 1.20; mental health, military service, RR=1.21, 95% CI=1.12, 1.32; civilians, RR=1.25, 95% CI=1.23, 1.26). Among men, these associations were somewhat attenuated in those with military service relative to civilians (physical health, military service, RR=1.13, 95% CI=1.09, 1.18; civilians, RR=1.20, 95% CI=1.17, 1.24; mental health, military service, RR=1.21, 95% CI=1.16, 1.27; civilians, RR=1.30, 95% CI=1.27, 1.34).
  
  
  CONCLUSIONS
  Relative to civilians, men and women with military service report more ACE, but associations of ACE with adult HRQOL are weaker among men with military service relative to civilians. There is a need to implement and disseminate evidence-based programs to prevent ACE and for research on the long-term health consequences of ACE in military populations.
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; the Veterans Affairs Office of Patient Care Services, Office of Women's Health Services, Department of Veterans Affairs, Washington, District of Columbia. Electronic address: jodie.katon@va.gov.
authors.forename: Jodie G
authors.initials: JG
authors.lastname: Katon
authors.affiliation: Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington;
authors.forename: Keren
authors.initials: K
authors.lastname: Lehavot
authors.affiliation: Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington;
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Simpson
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Sarah Beth
authors.initials: SB
authors.lastname: Barnett
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Grossbard
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Schure
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002649:Child Abuse / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D011788:Quality of Life; D012737:Sex Factors; D055815:Young Adult