Epidemiological evidence has consistently demonstrated elevated risks of adverse health outcomes including premature mortality associated with cumulative exposure to adverse childhood experiences (ACEs). This dissertation research seeks to explore the current prevalence of ACEs and positive childhood experiences such as social support, and theirinterrelationship with cardiometabolic health and premature mortality in the United States (US). Two nationally representative population-based data sources, namely the National Survey of Children’s Health (NSCH) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used. First, using Add Health, a longitudinal cohort of school-aged children
followed through young adulthood, we examined the association of ACEs with objectively measured cardiometabolic risk (CMR), and whether psychological health and social support modified the association between ACEs and CMR. Estimates are reported as beta coefficient or odds ratios (ORs) obtained from linear and logistic regressions. Second, using the same cohort, we examined the independent and joint associations of ACEs and social support with all-cause mortality through young adulthood. Analyses included Cox regressions to estimate mortality hazard ratios (HRs). Third, using NSCH data from 2016 to 2020, we examined state-level prevalence of ACEs and positive protective factors (PPFs) among US school-aged children. We find that cumulative exposure to ACEs significantly predicted overall cardiometabolic risk during young adulthood (b: 0.053 [95% CI: 0.002, 0.105]; p=0.041) after adjustment for potential confounders including social support. Exposure to 2 or more ACEs was associated with 51% greater hazards for premature all-cause mortality in the overall cohort (aHR: 1.51; 95% CI: 1.02, 2.23), and particularly among low social support group (aHR: 1.78; 95% CI: 1.15, 2.77). About 1 in 10 US children aged 6-17 experienced >2 ACEs (of 9 total) and ≤5 PPFs (of 7 total), with significant variations across states. To conclude, ACEs are highly prevalent among US children, and 2 or more ACEs are associated with elevated cardiometabolic risk and premature mortality through young adulthood. Social support modified the association of ACEs with obesity and premature mortality. Interventions that target to increase perceived social support in addition to ACEs prevention may reduce cardiometabolic risk and early deaths among young adults in the US.
