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. 2023 Jul 1;152(1):e2022060951.
doi: 10.1542/peds.2022-060951.

Positive Childhood Experiences and Adult Health Outcomes

Cher X Huang  1   2 , Neal Halfon  3   4 , Narayan Sastry  5 , Paul J Chung  3   4   6 , Adam Schickedanz  3
Affiliations

Positive Childhood Experiences and Adult Health Outcomes

Cher X Huang et al. Pediatrics. .

Abstract

Objectives: Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs.

Methods: The most recent 2017 wave of the Panel Study of Income Dynamics, a nationally representative study and its 2014 Childhood Retrospective Circumstances supplement (n = 7496) collected adult health outcomes, PCEs, and ACEs. Multivariable logistic regression assessed associations between PCE score and adult self-rated health or condition diagnosis, with and without ACEs adjustment. Cox proportional hazards models examined relationships between PCEs, ACEs, and annual risk of diagnosis.

Results: Adults with 5 to 6 PCEs had 75% (95% confidence interval [CI], 0.58-0.93) of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis (CI, 0.59-0.89) compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition (hazard ratio, 0.84; CI, 0.75-0.94); reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27-1.59).

Conclusions: PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Absolute increase in risk of reporting any physical or psychiatric condition across ACEs and PCEs score (reference group: 5–6 PCEs/0 ACEs). Results from main analytic model shown are absolute risk increases from models with PCEs and ACEs scores interacted. Covariates in the treatment model included continuous age, sex, a 5-category race/ethnicity measure, educational attainment, health insurance, and income as measured by percentage of federal poverty level. Survey weights were included in both the treatment and outcome model to accommodate the PSID’s complex survey design.
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Comment in

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