Non-response to ACE items is associated with demographic variables and health indicators in the 2021 Behavioral Risk Factor Surveillance System

Timothy J Grigsby; Madalyn Larson; Andrea Lopez; Sarah Sharmin; Ying Guo; Myriam Forster; Sheniz Moonie

doi:10.1016/j.pmedr.2024.102749

Non-response to ACE items is associated with demographic variables and health indicators in the 2021 Behavioral Risk Factor Surveillance System

Prev Med Rep. 2024 May 3:42:102749. doi: 10.1016/j.pmedr.2024.102749. eCollection 2024 Jun.

Authors

Timothy J Grigsby¹, Madalyn Larson², Andrea Lopez³, Sarah Sharmin⁴, Ying Guo⁵, Myriam Forster⁶, Sheniz Moonie³

Affiliations

¹ Department of Social and Behavioral Health, University of Nevada, Las Vegas, United States.
² Department of Social and Behavioral Health, University of Nevada, Reno, United States.
³ Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, United States.
⁴ Department of Demography, University of Texas at San Antonio, United States.
⁵ Department of Environmental and Occupational Health, University of Nevada, Las Vegas, United States.
⁶ Department of Health Sciences, California State University, Northridge, United States.

Abstract

Background: Adverse childhood experiences (ACE) encompass traumatic events occurring before age 18, with lasting impacts on health. While ACE disclosure is important for understanding these effects, some individuals decline to respond to ACE-related survey items due to sensitivity, privacy concerns, or psychological distress. This study explores the relationship between non-response to ACE items and health outcomes, shedding light on the implications for those who choose not to disclose.

Methods: We performed a secondary analysis of the 2021 Behavioral Risk Factor Surveillance System (BRFSS)-a national telephone survey querying health behaviors and conditions. Sociodemographic factors, ACE exposure, and non-response to ACE items were analyzed.

Results: Individuals who decline to respond to ACE items exhibit similar patterns of health behaviors and conditions as those reporting ACE exposure. Non-response is linked to both healthier behaviors (lifetime HIV testing) and riskier behaviors (higher odds of smoking and e-cigarette use). Moreover, non-responders have higher odds of being underweight or obese, experiencing concentration difficulties, reporting poor self-rated health, and reporting multiple health diagnoses including depression, diabetes, high blood pressure, heart attack, and stroke.

Conclusions: The study underscores the need to address health disparities associated with ACE, regardless of disclosure status. Healthcare interventions should target respondents and non-respondents of ACE screeners, tailoring strategies to promote healthier coping mechanisms and mitigate maladaptive behaviors. These results emphasize the importance of trauma-informed care, early intervention, and targeted public health initiatives for individuals affected by ACE, irrespective of their disclosure choices.

Keywords: ACE; BRFSS; Health; Non-response; Obesity; Smoking.