Document Type


Publication Date



Capstone Chair: M. LaNoue, TJU


Associations between adverse childhood experiences (ACEs) and adult health outcomes are well grounded in the empirical literature; such studies generally find both direct and indirect effects of ACE on health outcomes such as liver disease, cancer, and heart disease. In this study, the association between ACEs and chronic obstructive pulmonary disease (COPD) was examined, and smoking was assessed as a partial mediator in the ACE-COPD relationship. Data were collected from five states in which an eight category ACE module was included in the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were developed to test the mediational hypothesis-that smoking would partially mediate the ACE-COPD relationship. Regression models included categorical ACE score and eight ACE categories, including verbal abuse, physical abuse, sexual abuse, witnessed domestic violence, household substance abuse, mentally ill household member, parental separation or divorce, and incarcerated household member. Smoking was reduced to two categories, “current smoker” and “former/never smoked.” Covariates in each model included age, sex, race/ethnicity, body mass index, education, income, marital status, and asthma. Each individual ACE category and categorical ACE score was significantly associated with increased risk of smoking. In addition, individual ACE categories and categorical ACE score were related to increased likelihood of COPD. Both the relationships between individual ACE categories and COPD and categorical ACE score and COPD decreased in regression models including smoking, compared to models excluding smoking status, but the ACE-COPD association remained significant even after addition of smoking. Therefore, both the individual ACE categories and categorical ACE score supported the hypothesis that smoking is a partial mediator of the ACE-COPD relationship. Retention of significance in the ACE-COPD relationship after adjusting for smoking suggests that ACEs account for unique and significant variance. Findings and policy implications are discussed.

43 PowerPoint slides, no audio.

Included in

Public Health Commons