First-time exploration of adverse childhood experiences among adults in Delaware using BRFSS data: A cross-sectional study

OBJECTIVE: In 2019, for the first time, Delaware collected adverse childhood experiences (ACEs) data through the population-based Behavioral Risk Factor Surveillance System (BRFSS). The main objective of this study was to explore and delineate the prevalence of ACEs and determine their association with select chronic conditions/risk behaviors. STUDY DESIGN: A cross-sectional population-based study. METHODS: Delaware BRFSS 2019 data (N = 3,879) were analyzed. This includes 2,015 respondents with at least one ACE and 1,882 without ACE. Logistic regression was performed using SAS complex weighting procedures to compare the prevalence odds of selected conditions while controlling for age, gender, and race/ethnicity in Delawareans with and without ACEs. Delaware BRFSS participant response rate was 38.2% comparable to other federal survey responses. RESULTS: Nearly one in four adults reported high ACEs scores (≥3). Emotional abuse was the most common ACE. ACEs were significantly associated with poorer health outcomes. High ACE scores were more prevalent among women, multiracial/minority race groups, bisexual, lesbian/gay sexually oriented, younger age group, and less educated. Associations between high ACEs score and selected health conditions/behaviors remained statistically significant even after controlling for socio-demographic characteristics. CONCLUSION: Reporting of ACEs data is critical for Delaware's progress towards a Trauma-Informed State. A particularly disturbing finding was that a high number of young adults reported 3 or more ACEs. Strong association with chronic conditions, particularly mental health was a significant cause for concern. Study results present a first-time expansive coverage, providing stakeholders with a unique opportunity to prioritize evidence-based decisions in Trauma-Informed Delaware.