Doctoral Dissertations

Date of Award

8-2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Public Health

Major Professor

Kathleen C. Brown

Committee Members

Kathleen C. Brown, Laurie L. Meschke, Kristina W. Kintziger, Julia Jaekel

Abstract

Adverse childhood experiences (ACEs) have been linked to increased risk of negative health outcomes in later life. At least half of the population in Tennessee experience one ACE. Further, Tennessee ranks amongst the top five states in terms of cognitive decline in adult populations age 45 and above. To our knowledge, there is yet no study that has explored ACEs and adult health outcomes (health-related quality of life (HRQOL) and cognitive decline) in Tennessee.

The goal of this study was to examine the relationship between ACEs [by overall, individual, type/domain, and dose-response effect of ACE] and HRQOL as well as cognitive decline in the adult population in Tennessee. We also explored effect modification by emotional support and life satisfaction.

We used the data collected by the Tennessee Behavioral Risk Factor Surveillance System (BRFSS) in the years 2015 and 2016. The data included information regarding HRQOL among individuals age 18 and above, and cognitive decline among individuals age 45 and above. We performed bivariate and multivariable logistic regression to explore the association between ACEs and adult health outcomes (HRQOL and cognitive decline) using SAS (version 9.4). Based on the findings from individual ACE and adult health outcomes, we formed ACE scores to examine the dose-response effect of ACE on adult health outcomes.

Individuals exposed to ACEs, compared to those not exposed, had significantly higher adjusted odds of poor general health [AOR=1.55 (95%CI: 1.11, 2.16)], poor mental health [AOR=1.85 (95%CI: 1.04, 3.29)], activity limitation [AOR=1.92 (95%CI: 1.06, 3.46)], and confusion/memory loss [AOR=1.66 (95%CI: 1.08, 2.53)], controlling for confounding variables. We did not find a linear, dose-response relationship between ACE scores and adult health outcomes.

The findings confirm that ACEs have a long-term impact on adult health outcomes, particularly HRQOL and cognitive decline. To better mitigate the impacts of ACEs, interventions focusing on early screening of childhood adversities in a primary care setting, strengthening parenting skills by supporting parents through culturally appropriate training would be valuable for early prevention of ACEs.

Early assessment of ACEs and HRQOL as well as the cognitive decline would also support healthy aging of the adult population.

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