Evaluating the co-occurrence and exchangeability of adverse childhood experiences in 21 states

Olais, Jose Angel (2022) Evaluating the co-occurrence and exchangeability of adverse childhood experiences in 21 states. Masters thesis, Northern Arizona University.

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Abstract

Smoking is the leading cause of preventable disease, disability, and death in the US. There is strong evidence that current smoking is associated with adverse childhood experiences (ACEs), traumatic events that occur in childhood. This association is observed when comparing smoking prevalence across a cumulative exposure variable representing the number of ACEs experienced. However, no research to date has described specific ACE exposures, both individually and in combination, within a given cumulative count of adversities. Additionally, there is a recognized but largely untested assumption that individual ACEs (and ACE exposure categories) are equally prognostic for given health outcomes. Evaluating this assumption requires partitioning individual ACE exposures within each cumulative risk category. The first objective of this study was to partition the composition of individual ACE exposures within cumulative risk categories. The second goal was to evaluate the exchangeability assumption of the cumulative categorical risk model by comparing the individual ACE exposures that comprise a singleton and pair ACE category. In a national sample of 115,230 adults across 21 states, divorce, verbal abuse and physical abuse were the most common elements of singleton ACE exposures, and heterogeneity was observed for smoking prevalence, where persons experiencing divorce (18.7%) had substantially higher smoking prevalence than persons experiencing verbal abuse (11.5%) despite exposure to a single adversity. No heterogeneity was observed among the top three pairwise ACE clusters. This study provides evidence that individual ACE exposures are not exchangeable in terms of their association with smoking. The approach to partitioning ACE clustering described here provides a foundation for further evaluation of ACE exchangeability within higher cumulative exposure categories and among different health outcomes.

Item Type:	Thesis (Masters)
Publisher’s Statement:	© Copyright is held by the author. Digital access to this material is made possible by the Cline Library, Northern Arizona University. Further transmission, reproduction or presentation of protected items is prohibited except with permission of the author.
Keywords:	ACE co-occurence; Adverse childhood experiences; Current smoking; Education level; Trauma
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
NAU Depositing Author Academic Status:	Student
Department/Unit:	Graduate College > Theses and Dissertations College of Social and Behavioral Science > Psychological Sciences
Date Deposited:	13 Jun 2023 17:13
Last Modified:	04 Jan 2024 08:30
URI:	https://openknowledge.nau.edu/id/eprint/6009

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