title: Disability and Exposure to High Levels of Adverse Childhood Experiences: Effect on Health and Risk Behavior.
abstract: BACKGROUND
  Health disparities among persons with disabilities have been previously documented. However, there is little research specific to adverse childhood experiences (ACEs) in this population and how ACE exposure affects health outcomes in adulthood.
  
  
  METHODS
  Data from the 2012 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to compare the prevalence of ACEs between adults with and without disabilities and high ACE exposure (3-8 ACEs). Adjusted risk ratios of health risks and perceived poor health by disability status were calculated using predicted marginals.
  
  
  RESULTS
  A higher percentage of persons with disabilities (36.5%) than those without disabilities (19.6%) reported high ACE exposure. Among those with high ACE exposure, persons with disabilities were more likely to report several ACE categories, particularly childhood sexual abuse. In adjusted analyses, persons with disabilities had an increased risk of smoking (relative risk [RR] = 1.29; 95% CI, 1.10-1.51), poor physical health (RR = 4.34; 95% CI, 3.08-6.11), poor mental health (RR = 4.69; 95% CI, 3.19-6.87), and doctor-diagnosed depression (RR = 2.16; 95% CI, 1.82-2.56) compared to persons without disabilities.
  
  
  CONCLUSIONS
  The definition of disability derived from the BRFSS survey does not allow for those with disabilities to be categorized according to physical disabilities versus mental or emotional disabilities. In addition, we were unable to determine the timing of ACE exposure in relation to disability onset.
  
  
  CONCLUSIONS
  A better understanding of the life course associations between ACEs and disability and the impact of exposure to multiple types of childhood adversity on disability and health is needed to inform research and services specific to this vulnerable population.
authors.affiliation: CDC/CSTE applied epidemiology fellow, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina anna.austin@unc.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Austin
authors.affiliation: survey analyst, Statistical Services Branch, State Center for Health Statistics, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
authors.forename: Harry
authors.initials: H
authors.lastname: Herrick
authors.affiliation: head, Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
authors.forename: Scott
authors.initials: S
authors.lastname: Proescholdbell
authors.affiliation: disability and health specialist, Office on Disability and Health, Women and Children's Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Simmons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012309:Risk-Taking; D055815:Young Adult