title: Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood.
abstract: BACKGROUND
  Adverse childhood experiences (ACEs) are associated with early mortality and morbidity. This study evaluated the association among ACEs, high-risk health behaviors, and comorbid conditions, as well as the independent effect of ACE components.
  
  
  METHODS
  Data were analyzed on 48,526 U.S. adults from five states in the 2011 Behavioral Risk Factor Surveillance System survey. Exposures included psychological, physical, and sexual forms of abuse as well as household dysfunction such as substance abuse, mental illness, violence, and incarceration. Main outcome measures included risky behaviors and morbidity measures, including binge drinking, heavy drinking, current smoking, high-risk HIV behavior, obesity, diabetes, myocardial infarction, coronary heart disease, stroke, depression, disability caused by poor health, and use of special equipment because of disability. Multiple logistic regression assessed the independent relationship between ACE score categories and risky behaviors/comorbidities in adulthood, and assessed the independent relationship between individual ACE components and risky behaviors/comorbid conditions in adulthood controlling for covariates.
  
  
  RESULTS
  A total of 55.4% of respondents reported at least one ACE and 13.7% reported four or more ACEs. An ACE score ≥4 was associated with increased odds for binge drinking, heavy drinking, smoking, risky HIV behavior, diabetes, myocardial infarction, coronary heart disease, stroke, depression, disability caused by health, and use of special equipment because of disability. In addition, the individual components had different effects on risky behavior and comorbidities.
  
  
  CONCLUSIONS
  In addition to having a cumulative effect, individual ACE components have differential relationships with risky behaviors, morbidity, and disability in adulthood after controlling for important confounders.
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Campbell
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center, Charleston VA COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center, Charleston VA COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology* / Q000706:statistics & numerical data*; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States