Prevalence of Adverse Childhood Experiences (ACEs) and Associated Health Outcomes Among Young Women and Men in Honduras Open Access

Kappel, Rachel (Spring 2020)

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Background: Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur during childhood and have been shown to be associated with negative health outcomes. Most ACE studies to date have been in high-income countries with limited data on ACEs from low- and middle-income countries (LMICs). No ACEs studies have been done in Honduras. 

Objective: The purpose of this study is to assess the prevalence of and health consequences associated with ACEs in Honduras. This study examines the association between ACEs and health consequences to further establish if a dose-response relationship exists and if specific ACEs are more strongly predictive of individual health outcomes. Sex differences in prevalence of ACEs were also examined.

Participants and Setting: The Violence Against Children and Youth Survey (VACS) was conducted in Honduras between August and September 2017. In order to assess ACEs before age 18, data is restricted to participants ages 18-24 years old, resulting in a final sample size of 1,265 males and 1,436 females.

Methods: VACS is a nationally representative survey that uses a standardized methodology to measure child violence and other ACEs. This study estimated the weighted prevalence of individual ACEs (physical, emotional, and sexual violence; witnessing violence; parental migration) before age 18. Logistic regression analyses assessed the relationship between individual ACEs and cumulative ACEs and health outcomes (psychological distress; suicide ideation or self-harm; binge drinking; smoking; drug use; STIs; early pregnancy). Estimates were stratified by sex and chi-square tests examined differences by sex.

Results: An estimated 77% of 18-24 year olds in Honduras experience at least one ACE and 39% experience three or more ACEs. Physical violence is prevalent in Honduras, with an estimated 30.8% experiencing physical violence and 35.4% witnessing physical violence in the community. Females experience significantly more sexual abuse (16.2% vs. 9.9%) and emotional violence (14.7% vs. 7.7%) compared to males. A dose-response relationship exists between the count of ACEs and negative health outcomes with increased odds for psychological distress (aORs: 1.8, 2.8), suicidal ideation and self-harm (aORs: 2.3, 6.4), and smoking (aORs: 1.7, 1.9) for 1-2 ACEs and 3+ ACEs compared to no ACEs. The aORs were significantly higher for 3+ ACEs compared to no ACEs for binge drinking (aOR: 1.6), drug use (aOR: 4.0), STIs (aOR: 3.9), and early pregnancy (aOR: 1.7). Physical violence vicitimization and exposure in the community were both associated with increased odds of all health outcomes.


Conclusions: A majority of adolescents and young adults in Honduras are living with the consequences of ACEs. The high prevalence of ACEs and associated negative health outcomes in this population support the need for early intervention and prevention strategies in order to avoid the accumulation of traumatic experiences and disrupt the cycle of ACEs.

Table of Contents

Chapter 1: Introduction. 1

Problem Statement. 4

Theoretical Framework. 4

Purpose Statement. 5

Research Questions. 5

Significance Statement. 6

Chapter 2: Literature Review. 7

ACEs as a Global Health Concern. 7

ACEs in Honduras. 9

The Social Ecological Model for Understanding ACEs. 10

ACEs and Potential Health Outcomes. 12

Preventing ACEs. 13

Summary of Current Problem and Study Relevance. 14

Chapter 3: Student Contribution. 16

Chapter 4: Manuscript. 18

Abstract. 19

Introduction. 20

Methods. 23

Results. 29

Discussion. 32

References. 37

Chapter 5: Public Health Implications. 43

References. 47

Figures. 54

Figure 1. Three-Stage Stratified Random Sampling Method. 54

Figure 2. Table of Measures. 55

Tables. 59

Table 1. Characteristics of Honduras Males and Females aged 18 to 24. 59

Table 2. Cumulative Adverse Childhood Experiences and Health Outcomes in Honduras among 18-24 year olds. 61

Table 3. Adjusted Odds Ratios for the association between individual ACEs and specific health outcomes. 62

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