Impact of adverse childhood experiences, positive childhood experiences and adult protective and risk factors on health in a statewide representative sample

Abstract

Abstract Objective Adverse childhood experiences (ACEs), positive childhood experiences (PCEs) and adult protective and risk factors have each been associated with health outcomes but have rarely been examined together. We examined associations among ACEs, PCEs, adult protective and risk factors, and adult mental, behavioural, and physical health outcomes, including whether adult factors were independently associated with health after accounting for childhood experiences. Design Cross-sectional observational study. Setting California, USA. Participants Data were analysed from 24 453 adults categorised into 5 age categories (18–25, 26–39, 40–54, 55–64 and ≥65 years) participating in the 2021 California Health Interview Survey, a statewide representative survey. Analysis Outcomes included multiple mental, behavioural and physical health indicators, including composite measures of any physical condition and any mental/behavioural health condition. Weighted logistic regression models examined associations and interactions among ACEs, PCEs, adult protective and risk factors, and health outcomes, adjusting for age, gender and race/ethnicity. Additional models examined adult factors independent of ACEs and PCEs. Results Greater ACE exposure was associated with higher odds of most poor health outcomes, whereas higher PCE exposure was generally associated with lower odds across mental, behavioural and physical health outcomes. Compared with individuals with high ACE exposure and low PCE exposure, progressively less ACE exposure was associated with progressively lower odds of any mental/behavioural health condition (moderate ACEs OR=0.59, 95% CI 0.50 to 0.70; no ACEs OR=0.30, 95% CI 0.24 to 0.37) and any physical condition (moderate ACEs OR=0.75, 95% CI 0.64 to 0.88; no ACEs OR=0.58, 95% CI 0.45 to 0.75). Adult protective and risk factors remained independently associated with health outcomes after accounting for ACEs and PCEs. Higher cumulative protective factor exposure was associated with lower odds of any mental/behavioural health condition (OR=0.49, 95% CI 0.42 to 0.57) and any physical condition (OR=0.63, 95% CI 0.53 to 0.74). Conclusions Adult protective and risk factors were associated with health outcomes independent of ACEs and PCEs, extending prior ACE and PCE research beyond childhood experiences. Findings highlight the importance of healthcare and public health approaches that address both childhood and adult adversity and strengthen protective resources and supportive environments.