title: Examination of the Factorial Structure of Adverse Childhood Experiences and Recommendations for Three Subscale Scores.
abstract: OBJECTIVE
  The purpose of the current investigation is to assess and validate the factor structure of the Behavioral Risk Factor Surveillance System's (BRFSS) Adverse Childhood Experience (ACE) module.
  
  
  METHODS
  ACE data available from the 2009 BRFSS survey were fit using exploratory factor analysis (EFA) to estimate an initial factorial structure. The exploratory solution was then validated using confirmatory factor analysis (CFA) with data from the 2010 BRFSS survey. Lastly, ACE factors were tested for measurement invariance using multiple group factor analysis.
  
  
  RESULTS
  EFA results suggested that a 3-factor solution adequately fit the data. Examination of factor loadings and item content suggested the factors represented the following construct areas: Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse. Subsequent CFA results confirmed the 3-factor solution and provided preliminary support for estimation of an overall latent ACE score summarizing the responses to all available items. Measurement invariance was supported across both gender and age.
  
  
  CONCLUSIONS
  Results of this study provides support for the use of the current ACE module scoring algorithm, which uses the sum of the number of items endorsed to estimate exposure. However, the results also suggest potential benefits to estimating 3 separate composite scores to estimate the specific effects of exposure to Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse.
authors.affiliation: Northrop Grumman, Atlanta, Georgia and Division of Population Health, National Center for Chronic Disease Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Ford
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Merrick
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sharyn E
authors.initials: SE
authors.lastname: Parks
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Breiding
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Leah K
authors.initials: LK
authors.lastname: Gilbert
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Edwards
authors.affiliation: Northrop Grumman, and Division of Population Health, National Center for Chronic Disease Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Satvinder S
authors.initials: SS
authors.lastname: Dhingra
authors.affiliation: Department of Psychology, University of Hawaii at Manoa.
authors.forename: John P
authors.initials: JP
authors.lastname: Barile
authors.affiliation: Division of Birth Defects and Developmental Disabilities, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: William W
authors.initials: WW
authors.lastname: Thompson
keywords: ACEs; adverse childhood experiences; child abuse; child maltreatment; factor analysis