title: Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment.
abstract: BACKGROUND
  Adverse childhood experiences (ACE) have been previously linked to quality of life, health conditions, and life expectancy in adulthood. Less is known about the potential mechanisms which mediate these associations. This study examined how ACE influences adult health-related quality of life (HRQoL) in a low-income community in Florida.
  
  
  METHODS
  A community-based participatory needs assessment was conducted from November 2013 to March 2014 with 201 residents of Tampa, Florida, USA. HRQoL was measured by an excessive number of unhealthy days experienced during the previous 30-day window. Mediation analyses for dichotomous outcomes were conducted with logistic regression. Bootstrapped confidence intervals were generated for both total and specific indirect effects.
  
  
  RESULTS
  Most participants reported 'good to excellent health' (76%) and about a fourth reported 'fair to poor health' (24%). The mean of total unhealthy days was 9 days per month (SD ± 10.5). Controlling for demographic and neighborhood covariates, excessive unhealthy days was associated with ACE (AOR = 1.23; 95% CI: 1.06, 1.43), perceived stress (AOR = 1.07; 95% CI: 1.03, 1.10), and sleep disturbance (AOR = 8.86; 3.61, 21.77). Mediated effects were significant for stress (β = 0.08) and sleep disturbances (β = 0.11) as they related to the relationship between ACE and excessive unhealthy days.
  
  
  CONCLUSIONS
  ACE is linked to adult HRQoL. Stress and sleep disturbances may represent later consequences of childhood adversity that modulate adult quality of life.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B Downs, MDC56, Tampa, Florida, 33612, USA. asalinas@health.usf.edu.|REACHUP Inc., 2902 N, Armenia Avenue Suite 100, Tampa, Florida, 33607, USA. asalinas@health.usf.edu.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Salinas-Miranda
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, Texas, 77098, USA. Jason.Salemi@bcm.edu.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B Downs, MDC56, Tampa, Florida, 33612, USA. lking1@health.usf.edu.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: King
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, Florida, 33612, USA. jbaldwin@health.usf.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Baldwin
authors.affiliation: REACHUP Inc., 2902 N, Armenia Avenue Suite 100, Tampa, Florida, 33607, USA. LBerry@reachupincorporated.org.
authors.forename: Estrellita Lo
authors.initials: EL
authors.lastname: Berry
authors.affiliation: REACHUP Inc., 2902 N, Armenia Avenue Suite 100, Tampa, Florida, 33607, USA. DAustin@reachupincorporated.org.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Austin
authors.affiliation: REACHUP Inc., 2902 N, Armenia Avenue Suite 100, Tampa, Florida, 33607, USA. KScarborough@reachupincorporated.org.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Scarborough
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, Texas, 77098, USA. Kiara.Spooner@bcm.edu.
authors.forename: Kiara K
authors.initials: KK
authors.lastname: Spooner
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, Texas, 77098, USA. Roger.Zoorob@bcm.edu.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Zoorob
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, Texas, 77098, USA. Hamisu.Salihu@bcm.edu.
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D005431:Florida; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D011203:Poverty / Q000706:statistics & numerical data; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires