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The Hidden Role of Adverse Childhood Experiences

Maxia Dong, MD, PhD; Robert F. Anda, MS, MD; Vincent J. Felitti, MD; David F. Williamson, PhD; Shanta R. Dube, MPH; David W. Brown, MSPH, MS; Wayne H. Giles, MS, MD

Arch Pediatr Adolesc Med. 2005;159:1104-1110.

Background  Throughout US history, US society has been characterized by its high degree of residential mobility. Previous data suggest a relationship between mobility and increased health risk, but this relationship might be confounded by unmeasured adverse childhood experiences (ACEs).

Objectives  To examine the relationship of childhood residential mobility to health problems during adolescence and adulthood and to determine how much these apparent relationships may result from underlying ACEs.

Design, Setting, and Participants  Retrospective cohort study of 8116 adults who completed a survey that included childhood residential mobility, ACEs (childhood abuse, childhood neglect, and household dysfunction), and multiple health problems.

Main Outcome Measures  Number of childhood residential moves and number of ACEs (ACE score) were assessed for relationships to depressed affect, attempted suicide, alcoholism, smoking, early sexual initiation, and teenaged pregnancy.

Results  After adjustment for demographic variables, the risk of high residential mobility during childhood (8 moves) was 1.7- to 3.1-fold for each ACE, and increased with the number of ACEs. Compared with respondents who never moved, the odds of health risk for respondents with high mobility during childhood ranged from 1.3 (for smoking) to 2.5 (for suicide). However, when the number of ACEs was entered into multivariate models, the relationship between mobility and health problems was greatly reduced.

Conclusions  Adverse childhood experiences are strongly associated with frequent residential mobility. Moreover, the apparent relationship between childhood mobility and various health risks is largely explained by ACEs. Thus, previous studies showing a relationship between residential mobility and negative outcomes were likely confounded by unmeasured ACEs.

Author Affiliations: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Dong, Anda, Williamson, and Giles, Ms Dube, and Mr Brown); and Department of Preventive Medicine, Southern California Permanente Medical Group, San Diego (Dr Felitti). Dr Dong is now with the Behavioral and Clinical Surveillance Branch, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga.

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