Association of Adverse Childhood Experiences with Health Risk Behaviors Among College Students in Zambia

Zhang, Jie; Tang, Bowen; Liu, Mingwei; Yuan, Shuai; Yu, Hong-jie; Zhang, Rui; Xiaochang, Huang; Nzala, Selestine; Chikoya, Mpundu; Wang, Peigang; He, Qi-qiang

doi:10.1007/s12529-020-09863-y

Cited by 15 publications

(9 citation statements)

References 22 publications

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“…The person-centered approach or latent class analysis (LCA) has an advantage over the cumulative-risk approach in discerning potential subgroups of ACEs, which in turn, may exert different effects on health outcomes [33][34][35][36]. Some studies using LCA have discovered distinctive patterns of ACEs.…”

Section: Introductionmentioning

confidence: 99%

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

Wang

Kelifa

et al. 2021

Environ Health Prev Med

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Background Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates. Methods Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being. Results 86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = −0.096, 95% CI −0.176, −0.033), multiple ACEs (β = −0.338, 95% CI −0.498, −0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being. Conclusions Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

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Section: Introductionmentioning

confidence: 99%

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

Wang

Kelifa

et al. 2021

Environ Health Prev Med

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“…In previous studies with smaller samples of university students in specific countries, both binary (Wang et al, 2019;Zhang et al, 2020) and frequency (Karatekin, 2018) approaches to cumulative ACE exposure have predicted suicidality. Suicidality in our larger, international student sample was predicted only by cumulative ACEs, suggesting that repeated childhood experiences of abuse, neglect and violence are more likely than occasional experiences to create risk for suicidality in young adulthood.…”

Section: Relationship Between Ace Exposure and Mental Health Difficul...mentioning

confidence: 91%

“…The majority of research has been conducted in the United States, where the proportion of college students reporting at least one ACE has ranged from 48-75% (Forster et al, 2018;Karatekin, 2018;Khrapatina & Berman, 2017;Merians et al, 2019;Windle et al, 2018). In the few studies conducted with university populations outside the United States, the percentage of students reporting at least one ACE varies even more considerably: for example, 20% in the Ukraine (Burlaka et al, 2020), 45% in China (Ji & Wang, 2018), 50% in Korea (Kim, 2017), 56% in Northern Ireland (McGavock & Spratt, 2014), 58% in Zambia (Zhang et al, 2020), 74% in both Hong Kong (Ho et al, 2019) and Germany (Weihn et al, 2018) and 86% in Eritrea (Kelifa et al 2020). The proportion that meets the threshold of four ACEs identified by Hughes et al (2017) as significantly increasing the risk for mental illness is similarly diverse across countries: for example, 32% in Watt et al's (2020) United States study, 25% in Germany (Weihn et al, 2018), 19% in Hong Kong (Ho et al, 2019), 12% in Northern Ireland (McGavock & Spratt, 2014) and 8% in Korea (Kim et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Direct comparisons of ACE prevalence between university students in different countries is limited by measurement variation. For example, some studies have used all ten items from Felliti et al's (1998) original ACE measure (Khrapatina & Berman, 2017;Watt et al, 2020;Windle et al, 2018), some have used only selected items from that scale, leaving out ACEs such as emotional and physical neglect (Burlaka et al, 2020, Karatekin, 2017Zhang et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Adverse childhood experiences and adulthood mental health: a cross-cultural examination among university students in seven countries

et al. 2022

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While there is evidence that histories of adverse childhood experiences (ACEs) are common in university students and are associated with an increased risk of mental health difficulties, current research has limited geographic and cross-cultural representation. Comparing ACEs across diverse contexts using a standardized measure can illuminate geographic and sociocultural similarities or differences in exposure. The present study aimed to assess the prevalence of ACEs and their relationship with mental health symptoms in university students from seven countries.We sampled 5,945 university students from the United States, Canada, England, South Africa, Spain, Argentina and Uruguay. Participants completed the Adverse Childhood Experiences International Questionnaire (ACE-IQ) and the Inventory of Depression and Anxiety Symptoms (IDAS). Most participants (94.8%) reported exposure to at least one type of ACE and 61% reported exposure to four or more types. Repeated exposure to at least one ACE was reported by 70.2% and repeated exposure to at least four ACEs was reported by 21.2%. Spanish students had significantly lower ACE exposure than other students. Cumulative exposure to any ACE was significantly higher among students in lower income countries but when repeated exposure was considered these differences fell away. For the total sample, cumulative ACE exposure was significantly associated with increased severity of depression, anxiety and suicidality. Findings indicate that universities globally should be guided by a trauma-informed approach that recognizes students as a psychologically vulnerable group carrying a long-standing burden of childhood adversity.

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“…Thus, in order to effectively design and implement culturally relevant and evidence-based interventions to prevent ACEs and their negative health consequences, country-specific investigation is necessary (Ameli et al, 2017) and especially outside of the United States and Europe. Although ACEs are prevalent in Zambia (Nguyen, Padilla, et al, 2019), research regarding the nature, consequences, and implications of ACEs in Zambia has been limited (Beyene et al, 2019; Escueta et al, 2014; Nguyen, Padilla, et al, 2019; Uzoezie, 2018; Zhang et al, 2020). Given the median age of the country is 16.9 years and a majority of the population are children (CIA, 2020) and there are one million orphans in the country (more than 5% of the country population; Martosko, 2019), investigating prevalence of ACEs and their associated health outcomes can help inform efforts to prevent ACEs and build resilience among affected populations in Zambia.…”

Section: Introductionmentioning

confidence: 99%

Adverse Childhood Experiences and Associated Mental Distress and Suicide Risk: Results From the Zambia Violence Against Children Survey

Lee

Massetti

Perry

et al. 2021

J Interpers Violence

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Purpose: Adverse childhood experiences (ACEs) are a global public health concern. Little research exists on the prevalence and health consequences of ACEs in Zambia. The current study examined associations between individual and cumulative ACEs, mental distress, and suicide risk among Zambian youth. Methods: Data from Zambia Violence Against Children and Youth Survey were used (18-24 years old, n=1034). Bivariate and adjusted logistic models were performed with independent variables (i.e., experienced physical violence (PV), sexual violence (SV), and emotional violence (EV); witnessed intimate partner violence (IPV) and community violence (CV); orphan status; cumulative ACE exposure) and dependent variables (i.e., mental distress and suicide risk). Adjusted models controlled for demographic and social characteristics. Results: 76.8% of Zambian youth experienced one or more ACEs, and more than 30% witnessed CV (38.4%) or IPV (30.2%), or experienced PV (35.1%), prior to age 18. 27.5% were orphans, and less than 20% experienced EV (17.3%) or SV (15.4%) in childhood. 42.4% experienced mental distress in the past 30 days, and 12.5% reported lifetime suicidal thoughts or suicide attempts. PV, EV, cumulative ACE exposure, older age, being single, and stronger friendships were significantly related to experiencing mental distress. Cumulative ACEs exposure was associated with significantly higher suicide risk. Conclusions: Preventing ACEs can reduce mental distress and suicide risk among Zambian youth. Youth with cumulative ACE exposure can be prioritized for mental health intervention. More research is warranted to investigate the broad-based prevention of ACEs, especially PV and EV, and protective factors that can promote resilience among youth who have experienced ACEs.

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Association of Adverse Childhood Experiences with Health Risk Behaviors Among College Students in Zambia

Cited by 15 publications

References 22 publications

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

Adverse childhood experiences and adulthood mental health: a cross-cultural examination among university students in seven countries

Adverse Childhood Experiences and Associated Mental Distress and Suicide Risk: Results From the Zambia Violence Against Children Survey

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