Adverse Childhood Experiences (ACEs) among reproductive age women: Findings from the 2019 BRFSS

Abstract

Background and Significance: The 1998 Adverse Childhood Experiences ACE Study defines ACEs as ten categories of abuse, neglect, and family stressors before age 18. ACEs contribute to poor health and wellbeing for all genders across the lifespan. Despite rising premature mortality among women, and the impact of childhood adversity on girls and women, scant research examines trends in ACEs among women of reproductive age. Methods: This study utilizes the 2019 BRFSS Survey and focuses on women and men ages 18-39 in 17 states. The study first analyses gender differences in ACE score and specific ACE exposures. The study then examines age differences in ACE scores between four age cohorts of women of reproductive age (18-24, 25-29, 30-34, 35-39 years). Finally, the study analyses associations between womens ACEs scores and adult physical and mental health, self-reported BMI categories, history of depression, and fair to poor overall health by age cohort. Results: Findings revealed a higher prevalence of 4+ ACE scores among women as compared to men ages 18-39 years (5.42% difference). A greater proportion of women experienced sexual abuse (16.49% vs. 5.91%), lived with someone experiencing mental illness (22.16% vs. 15.44%), with alcohol abuse (22.31% vs. 18.32%) and drug/prescription medication abuse (13.58% vs.12.16%), and witnessed domestic violence at home (16.59% vs. 12.84%) compared to men. Younger reproductive age women (18-24 years) experienced a greater prevalence of 4+ ACEs (24.67%) as compared to older reproductive age women (35-39 years) (20.06%; 4.61% difference). In contrast to those without a history of ACEs, women with 4+ ACEs were 1.59 (95% CI, 1.41-1.78) times as likely to develop obesity, 3.46 (95% CI 3.07-3.90) times as likely to have a history of depression, and 1.68 (95% CI 1.45-1.94) times as likely to report fair or poor health. Discussion: ACEs are associated with significant health problems among reproductive age women. These findings provide a critical foundation for future social epidemiology research focused on this population. Awareness of the prevalence and impact of ACEs must be included in public health planning, policy, and practice to improve the health of reproductive age women.

Acknowledgements

I would like to thank Dr. Joe Feinglass for his mentorship of this work and investment in my training. Jointly, we would like to thank Dr. Audrey Stillerman and Bridget Gavaghan for their partnership in this work. All stakeholders have been updated on the progress of this research; they will receive the final paper once completed, and discussion of findings will be communicated through virtual channels.

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