Adverse Childhood Events and Associated Health Outcomes and Risk Behaviors Among a National Sample of Men Who Have Sex with Men Público

Abstract

Adverse Childhood Events (ACEs), including measures of abuse and household dysfunction, have been associated with negative health outcomes and risk behaviors in adulthood. ACEs have not been extensively studied among men who have sex with men (MSM). We aimed to describe the prevalence of ACE exposure and its associated HIV and sexually transmitted infection (STI) related health outcomes and risk behaviors among a nationwide sample of MSM. Data were obtained from the 2015 cycle of the American Men’s Internet Survey (AMIS), an annual cross-sectional survey of MSM living in the United States, obtained via online convenience sampling. The 2015 cycle of AMIS contained questions related to 8 ACE exposure categories in the first 18 years of life. Individuals with sufficient data for all categories were assigned an ACE score. Outcome and demographic measures were also reported by AMIS study participants. Multiple log-binomial models were fit to analyze the association between ACE exposure, including any exposure and exposure to individual ACE categories, and the following health outcomes and risk behaviors: STI testing, STI diagnosis, HIV-positive status, illicit substance use, and condomless anal intercourse (CAI). Among the 3,353 individuals randomized to receive the ACE questionnaire, 2,590 completed a sufficient portion to receive an ACE score. 79.7% of these participants reported exposure to one or more ACE category, with significant differences in reporting exposure by race/ethnicity, annual income, and educational attainment. In our multivariable models controlling for demographics, we found significant differences in STI testing, illicit substance use, and engagement in CAI by any ACE exposure (adj-PR: 1.07, 95% CI): 1.00, 1.15, p-value: 0.0432; adj-PR: 1.23, 95% CI: 1.05, 1.46; adjusted-PR: 1.12, 95% CI: 1.03, 1.21, respectively). We found that exposure to divorced or separated households, substance abuse, psychological abuse and mental illness were key drivers in differences in our analyzed outcomes. Our findings indicate a high overall ACE burden among MSM nationally, with potential consequences in later life. Trauma informed care, which involves screening for trauma and recognizing its potential impacts, and ACE prevention strategies should be implemented to mitigate current and future impacts of ACE exposure.

Table of Contents

Background........................................................................................... 1

Methods................................................................................................. 3

Results................................................................................................... 8

Discussion........................................................................................... 10

Future Directions................................................................................. 13

References........................................................................................... 16

Table 1................................................................................................. 23

Table 2................................................................................................. 26

Table 3a............................................................................................... 27

Table 3b............................................................................................... 28

Table 3c............................................................................................... 29

Table 4a............................................................................................... 30

Table 4b............................................................................................... 31

Supplemental Table 1......................................................................... 32

Supplemental Table 2......................................................................... 33

Supplemental Table 3......................................................................... 34

Supplemental Table 4......................................................................... 35

Supplemental Table 5......................................................................... 36

Supplemental Table 6......................................................................... 37

Supplemental Table 7......................................................................... 38

Supplemental Table 8......................................................................... 39

Supplemental Table 9......................................................................... 40

Supplemental Table 10....................................................................... 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Sexual Health MSM Adverse Childhood Events
Committee Chair / Thesis Advisor	Sanchez, Travis, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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