Introduction
The Behavioral Risk Factor Surveillance System is a national health-related survey
with an optional adverse childhood experience (ACE) module. States use varying methodologies,
question formats, and sampling frames, and little guidance exists for conducting multistate
explorations of adverse childhood experiences. In this study, 6 adverse childhood
experience scoring approaches are compared, and practical recommendations are offered
for when and how each approach can be utilized most effectively.
Methods
This study used 2015 Behavioral Risk Factor Surveillance System data from the adverse
childhood experience module administered by 6 states. Data were merged and analyzed
between 2018 and 2021. To understand how adverse childhood experience scoring may
impact estimates of association, concordance/discordance among 6 approaches (continuous
versus categorical, states that collected all adverse childhood experiences versus
those that collected any adverse childhood experiences, and normalized versus standard
scores) was evaluated. Using separate weighted multivariable logistic regression models
controlling for confounders, the relationship between adverse childhood experiences
using each approach and the presence of 10 chronic health conditions was also assessed.
Results
Comparisons revealed discordance for categorical versus continuous approaches (30%)
and all-ACEs versus any-ACEs (20%) but full concordance for standard versus normalized
approaches. Discordance occurred more frequently with low-prevalence outcomes (≤7.0%)
and lower-exposure samples (any-ACEs).
Conclusions
Results revealed general concordance across adverse childhood experience scoring approaches
when outcomes commonly occurred and when the sample was limited to just states that
asked the full array of adverse childhood experiences. However, on a deeper exploration
of discordant findings, specific nuances were uncovered that may help guide researchers
when deciding on which approach to use on the basis of the research question and conceptual
model driving study objectives.
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REFERENCES
Boullier M, Blair M. Adverse childhood experiences. Paediatr Child Health. 2018;28(3):132‒137. https://doi.org/10.1016/j.paed.2017.12.008.
Sacks V, Murphey D. The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity, Child Trends; Bethesda, MD 2018. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity. Published February 12Accessed April 14, 2019.
Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020;20(1):1327. https://doi.org/10.1186/s12889-020-09411-z.
- Toxic stress in children and adolescents.Adv Pediatr. 2016; 63: 403-428https://doi.org/10.1016/j.yapd.2016.04.002
About BRFSS. Centers for Disease Control and Prevention. https://www.cdc.gov/brfss/about/index.htm. Updated May 16, 2014. Accessed November 19, 2018.
- BRFSS adverse childhood experience (ACE) module.Centers for Disease Control and Prevention, Atlanta, GA2021 (Accessed December 13)
- A data users guide to the BRFSS physical activity questions: how to assess the 2008 physical activity guidelines for Americans.Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA2021 (Accessed December 13)
- National weighting of data from the Behavioral Risk Factor Surveillance System (BRFSS).BMC Med Res Methodol. 2016; 16: 155https://doi.org/10.1186/s12874-016-0255-7
- Data-driven primary prevention strategies for adverse childhood experiences.ASTHO, Arlington, VA2019 (Published JulyAccessed December 13, 2021)
- Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor.BMJ Open. 2017; 7e013228https://doi.org/10.1136/bmjopen-2016-013228
- Childhood adversity and asthma prevalence: evidence from 10 US states (2009-2011).BMJ Open Respir Res. 2014; 1e000016https://doi.org/10.1136/bmjresp-2013-000016
- Adverse childhood experiences and geriatric depression: results from the 2010 BRFSS.Am J Geriatr Psychiatry. 2015; 23: 110-114https://doi.org/10.1016/j.jagp.2014.08.014
- Adverse childhood experiences and the risk of depressive disorders in adulthood.J Affect Disord. 2004; 82: 217-225https://doi.org/10.1016/j.jad.2003.12.013
- Adverse childhood experiences: expanding the concept of adversity.Am J Prev Med. 2015; 49: 354-361https://doi.org/10.1016/j.amepre.2015.02.001
- Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states [published correction appears in JAMA Pediatr. 2018;172(11):1104].JAMA Pediatr. 2018; 172: 1038-1044https://doi.org/10.1001/jamapediatrics.2018.2537
- Vital signs: estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention - 25 states, 2015-2017.MMWR Morb Mortal Wkly Rep. 2019; 68: 999-1005https://doi.org/10.15585/mmwr.mm6844e1
- Adverse childhood experiences and the risk of diabetes: examining the roles of depressive symptoms and cardiometabolic dysregulations in the Whitehall II cohort study.Diabetes Care. 2018; 41: 2120-2126https://doi.org/10.2337/dc18-0932
- Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study.Am J Prev Med. 1998; 14: 245-258https://doi.org/10.1016/s0749-3797(98)00017-8
- The dimensionality of adverse childhood experiences: a scoping review of ACE dimensions measurement.Child Abuse Negl. 2021; 121105270https://doi.org/10.1016/j.chiabu.2021.105270
- Measurement of adverse childhood experiences: it matters.Am J Prev Med. 2021; 61: 821-830https://doi.org/10.1016/j.amepre.2021.05.043
- Behavioral Risk Factor Surveillance System comparability of data BRFSS 2015.Centers for Disease Control and Prevention, 2016 (Updated JuneAccessed December 13, 2021)
- Behavioral Risk Factor Surveillance System ACE data.Centers for Disease Control and Prevention, 2020 (Updated April 3Accessed July 13, 2020)
- Adverse childhood experiences, mental health, and excessive alcohol use: examination of race/ethnicity and sex differences.Child Abuse Negl. 2017; 69: 40-48https://doi.org/10.1016/j.chiabu.2017.04.004
- Behavioral Risk Factor Surveillance System: weighting BRFSS data 2015.Centers for Disease Control and Prevention, Atlanta, GA2015 (PublishedAccessed December 13, 2021)
- Disparities in adverse childhood experiences among sexual minority and heterosexual adults: results from a multi-state probability-based sample.PLoS One. 2013; 8: e54691https://doi.org/10.1371/journal.pone.0054691
- Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years.PLoS One. 2019; 14e0211850https://doi.org/10.1371/journal.pone.0211850
- Long term physical health consequences of adverse childhood experiences.Sociol Q. 2015; 56: 723-752https://doi.org/10.1111/tsq.12107
- Practical Statistics for Medical Research.1st ed. Chapman & Hall, London, United Kingdom1990
- Chapter 10. Precision and statistics in epidemiologic studies.Modern Epidemiology. Lippincott Williams & Wilkins, Philadelphia, PA2008
Article Info
Publication History
Published online: February 01, 2022
Identification
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
