Study On Related Factors Of Adverse Childhood Experiences Of Medical College Students In Anhui Province

ObjectiveTo demonstrate the magnitude of adverse childhood experiences(ACEs), and reveal the risk factors for ACEs among medical college students in Anhui province. Relationships between ACEs and health risk behaviors were also explored. To determine the association between multiple ACEs and both alcohol abuse and cigarette use in order to improve teen-age health and reduce alcohol abuse among college students.MethodsUsing stratified cluster sampling method, 2073 students were randomized to chosen and investigated by an anonymous, self-administrated questionnaire about childhood abuse, neglect and household dysfunction. 10 categories of ACEs are composed of abuse (physical, emotional, or sexual); neglect (physical or emotional); and growing up with household substance abuse, criminality of household members, mental illness among household members, battered mother and parental discord. Data was analyzed with Epidata6.04 and SPSS11.5 software and methods of Logistic regression, Kruskal-Walls test and chi-square etc.The associations between parental substance abuse, ACEs, and personal substance abuse were assessed by logistic regression analyses. The 4 categories of personal alcohol abuse included the following: ever heavy drinking, self-reported alcohol problems, self-reported alcoholic, and ever marrying an alcoholic during adulthood. The associations between ACEs and both cigarette use and other problems were assessed by logistic regression analyses. The main outcomes measured were smoking initiation by age 14 years, 15 to 17 years , 18 to 20 years, or after age 21 years, and status as ever, current, or heavy smoker. In this cross-sectional study of 2 073 Chinese medical students, the case cohort included persons of smoking while the control cohort consisted of people of no smoking.ResultsThe prevalence of ACE was relevantly high among these students. Sixty-eight percent of respondents reported at least 1 of 10 categories. Over one third of respondents reported at least 2 of the 10 categories. The highest prevalence belongs to physical neglect, secondly physical abuse. Both the prevalence of physical neglect and physical abuse were as high as nearly thirty percent. There was no significant difference of the prevalence of ACE score among different habitation and gender(P>0.05), while significant difference of the prevalence of ACE score among variant parental education degree(P<0.05).Both the prevalence and risk(adjusted odds ratio) increased for smoking, alcoholism, physical inactivity, depressed mood, and suicide attempts as ACE score increased. We also found a significant(P<0.05)dose-response relationship between ACE score and each of the 10 risk factors for the leading causes of death that we studied.Compared with subjects without parental alcoholism, the adjusted odds ratio (OR) for each ACE was 2 to 14 times more if either parent or both parents abused alcohol (P<0.05). Subjects with bi-parental alcoholism had the biggest likelihood of ACEs. Compared with subjects without ACE, the risk of personal alcohol abuse were increased 2- to 4-fold if there was any ACE, regardless of parental alcoholism (P<0.05). The total number of ACEs (ACE score) had a graded relationship to 4 categories of personal alcohol abuse with or without parental alcoholism. The prevalence of personal alcohol abuse among subjects with parental alcoholism was higher, which was independent of ACE score.Compared with those reporting no ACEs, all individual ACE increased the risk for each smoking behavior (P<0.05). Initiating tobacco use by age 14 years was increased two- to threefold by individual ACEs (P<0.05). ACEs also accounted for a 20% to 90% increased likelihood of tobacco use initiated during mid adolescence (15-17 years). ACE score had a very strong graded relationship to each smoking behavior (P<0.05). For any given ACE score, recent depression was more common among smokers than nonsmokers.ConclusionThis is the first study to assess ACEs in China. We found that the relationship between ACE score and 10 risk factors for the leading causes of death was strong and cumulative among medical college students in Anhui. Primary prevention of ACEs and improved treatment of exposed children could reduce health risk factors and disease conditions among adolescents and adults. Efforts will be taken to prevent and treat children who have ACEs, and subsequently can reduce substance abuse and later problems.