Assessment of Adverse Childhood Experiences in the South Bronx on Risk of Developing Chronic Disease as Adults

BackgroundAdverse Childhood Experiences (ACE) have a negative impact on health outcomes. Using a cross-sectional study design, our objective was to identify the prevalence of ACEs among residents of the South Bronx and the relationship between such childhood stressors and prevalence of both chronic disease and modifiable high-risk behavior in adulthood. MethodsWe recruited patients from a hospital-based adult primary care clinic in the metropolitan area of South Bronx. A cross-sectional survey was conducted between September 2017 and January 2018, using a modified ACE Questionnaire, that included nine ACE categories (Physical Abuse, Sexual Abuse, Household Substance Abuse, Separation from Parents, Incarcerated Household Member, Parental Separation/Divorce, and Bullying), and in addition to questions on demographics, high-risk behavior, and diagnosis of chronic disease. Our primary objective was to gather incidence of ACEs organized by domains. Secondary objectives were to demonstrate any expected increase (as Odds Ratio) in Chronic Disease or maladaptive social habits when compared to patients with no ACEs within the cohort. ResultsA total of 454 patients completed the survey. The average age was 53.1{+/-}14.2 years and females were 49% of the sample. Hispanics were 61% followed by Blacks at 34%. Participants reported high-risk behavior in 24%, had a high prevalence of chronic illness (82%) and ACE events at 70%. We found a significant relationship between ACE events and having a chronic disease diagnosis and engagement in high-risk behavior with higher odds of reporting chronic illnesses among participants with exposure to childhood stressors (OR 1.26, 95% confidence interval 1.1-1.5, p=0.002). Of the nine ACE categories many were independently associated with one or more chronic diseases in adulthood. ConclusionAccording to our survey data, ACE events in our patient population were more prevalent (30% with 4 or more exposures), higher than the proposed average of 1 out of 6 Americans with 4 or more exposures nationally according to the national statistics. These childhood stressors appear to have a strong association with development of high-risk behavior and chronic illnesses.