Association of adverse childhood experiences and health risk behaviors among young adults visiting a regional primary healthcare center, Federation of Bosnia and Herzegovina

Abstract

BackgroundMany studies have linked adverse childhood experiences (ACEs) to long-term health outcomes, as well as health risk behaviors. In the post-war period in Bosnia and Herzegovina, many young people grew up in an environment of deteriorated living standards due to high unemployment and economic insecurity. The objectives of the study were to: 1) describe the health risk behaviors of young adults accessing primary healthcare; and 2) examine associations of these risk factors with adverse childhood experiences in this context.MethodsThis was a cross-sectional survey, conducted from April to October 2014. Participants were recruited from the Primary Healthcare Center Zenica. Patients between the ages of 18 and 24 were eligible for inclusion. The informed consent and self-administered questionnaire were offered to patients during clinic intake. The questionnaire contained questions on sexual and reproductive health, use of alcohol and drugs, dating violence, and adverse childhood experiences.ResultsDuring the study period 520 questionnaires were distributed, and 400 complete surveys were returned, for a response rate of 76.9%. Among the 400 respondents, 166 were males (41.5%) and 234 were females (58.5%). Our study showed that 48.7% of respondents had experienced some form of childhood adversity. Emotional neglect was the most common type of adverse childhood experience (25.6%) and was significantly more prevalent among females. Our study indicated that more than 15% of respondents had witnessed domestic violence. Overall, ACEs were associated with increased odds of early sex initiation, alcohol use, drug use, and dating violence, although some of these associations did not reach statistical significance. Emotional neglect was the exception, and reporting emotional neglect was associated with a significantly elevated odds ratio for all four of the health risk behaviors. Emotional abuse was associated with an increased odds of drug abuse (OR = 2.78; 95% CI = 1.31–5.90) and dating violence (OR = 2.31; 95% CI = 1.10–4.89). Sexual abuse was marginally associated with increased early sex initiation (OR = 3.2; 95% CI 0.93–10.8). Parental divorce was significantly associated with alcohol abuse.ConclusionThe results of this study demonstrated associations between adverse experiences in childhood and the probability of engaging in health risk behavior which has implications for health outcomes in the long-term.

Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood

“…When all individual types of abuse were considered together in the current study, most relationships with adult violence outcomes were attenuated but remained significant, suggesting child abuse in general, regardless of type, increases the risk of PA, IPV, and SV in adulthood. Further, consistent with findings elsewhere [ 19 , 22 , 23 , 26 – 28 ], the current study demonstrated a cumulative impact of child abuse on risk of violence revictimisation. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to report PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years.…”

“…Compared to those who had no history of ACEs, individuals with experience of one ACE were over one and a half times more likely to have been a victim of violence in the past year, increasing to over four times more likely for those with 2-3 ACEs, and over seven times more likely for those with four or more ACEs [19]. This doseresponse relationship between childhood adversity and experience of violence in adulthood has also been replicated in several studies across different countries [23][24][25][26]. To date however, there are a limited number of studies which examine the relationship between childhood abuse and different forms of adult interpersonal violence.…”

Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China

“…Among the ACE subtypes, emotional abuse (56.94 %) and emotional neglect (51.76 %) were the most commonly reported, followed by physical abuse (38.15 %) and physical neglect (38.12 %), suggesting a high prevalence of maltreatment and staggering incidence of emotional maltreatment. In a cross-sectional survey of 520 respondents from regional primary healthcare centers in Bosnia and Herzegovina, it was found that emotional neglect was the most common type of ACE (25.6 %) and was significantly more prevalent among women [ 23 ]. Another study showed that at least 30 % of participants reported emotional neglect and physical neglect, while 40 % reported emotional abuse [ 24 ].…”

Adaptação transcultural do Adverse Childhood Experiences International Questionnaire

“…O ACE Study, realizado em San Diego e conduzido pelo Departamento de Medicina Preventiva da Kaiser Permanente ® em parceria com o Centro de Controle e Prevenção de Doenças dos Estados Unidos (CDC), é considerado um marco na investigação da exposição ao abuso e negligência durante a infância como fator de risco associado a desfechos negativos de saúde e bem-estar ao longo da vida 3,4 . A partir de sua publicação, diversos estudos epidemiológicos foram conduzidos, dando ênfase a uma crescente preocupação mundial sobre as consequências dos maus-tratos infantis, não somente imediatas, mas também a longo prazo [5][6][7] .…”