Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales

BMJ Open. 2023 Apr 17;13(4):e072916. doi: 10.1136/bmjopen-2023-072916.


Objectives: Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms.

Design: Secondary analysis of combined data from eight cross-sectional general population ACE surveys.

Setting: Households in England and Wales.

Participants: 20 556 residents aged 18-69 years.

Measures: Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure.

Results: Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined.

Conclusion: Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.

Keywords: Child protection; Community child health; MENTAL HEALTH; PUBLIC HEALTH; Quality of Life; Substance misuse.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adverse Childhood Experiences*
  • Binge Drinking*
  • Cross-Sectional Studies
  • England / epidemiology
  • Female
  • Humans
  • Obesity
  • Pregnancy
  • Wales / epidemiology