The Relationship of Adverse Childhood Events to Smoking, Overweight, Obesity and Binge Drinking Among Women in Hawaii

Abstract

Objectives: To evaluate how the associations of adverse childhood events (ACEs) with smoking, overweight, obesity and binge drinking differ by race/ethnicity among women, including a large, understudied cohort of Asians and Native Hawaiians/Pacific Islanders (NHOPIs).

Methods: The number and type (household dysfunction, and physical, verbal and sexual abuse) of ACEs were examined in relation to adulthood smoking, overweight, obesity and binge drinking among 3354 women in Hawaii using the 2010 Behavioral Risk Factor Surveillance System data using Poisson regression with robust error variance. We additionally investigated for interaction by race/ethnicity. Covariates included age, race/ethnicity, education, emotional support, healthcare coverage, and the other health outcomes.

Results: Overall, 54.9 % reported at least 1 ACE. The prevalence of smoking (PR = 1.40 (1 ACE) to PR = 2.55 [5+ ACEs]), overweight (PR = 1.22 [1 ACE] to PR = 1.31 [5+ ACEs]) and obesity (PR = 1.00 [1 ACE] to PR = 1.85 [5+ ACEs]) increased with increasing ACE count. Smoking was associated with household dysfunction (PR = 1.67, CI = 1.26-2.22), and physical (PR = 2.04, CI = 1.50-2.78) and verbal (PR = 1.62, CI = 1.25-2.10) abuse. Obesity was also significantly related to household dysfunction (PR = 1.22, CI = 1.01-1.48), and physical (PR = 1.36, CI = 1.10-1.70), verbal (PR = 1.35, CI = 1.11-1.64) and sexual (PR = 1.53, CI = 1.25-1.88) abuse. Among Asians, sexual abuse was associated with a lower prevalence of binge drinking (PR = 0.26, CI = 0.07-0.93), which was significantly different from the null association among Whites (interaction p = 0.02).

Conclusion: Preventing/addressing ACEs may help optimize childhood health, and reduce the likelihood of smoking/obesity among women including Asians/NHOPIs. Further studies are warranted to evaluate the sexual abuse-binge drinking association among Asians, which may support the need for culturally-tailored programs to address ACEs.

Keywords: Adverse childhood events; Asians, Native Hawaiians and Pacific Islanders; Binge drinking; Obesity; Smoking; Women’s health.

Figure 1. Weighted percentages of women in Hawaii reporting adverse childhood events by major categories (household dysfunction and physical, verbal and sexual abuse) and individual items within each category, Hawaii BRFSS, 2010

NOTE: With the exception of the item, ‘Witness domestic violence’, the response for each household dysfunction item was ‘Yes’ or ‘No’. For the household item, ‘Witness domestic violence’, and the categories of physical, verbal and sexual abuse, responses included ‘Once’, ‘More than once’ or ‘Never’. With the exception of verbal abuse, a response of at least ‘Once’ defined the presence of the corresponding ACE. For verbal abuse, a response of ‘More than once’ was necessary to count as the presence of verbal abuse in the study.

Figure 2. Weighted percentages of women reporting adverse childhood events by race/ethnicity, Hawaii BRFSS, 2010

NHOPI=Native Hawaiians and Pacific Islanders