Positive and Adverse Childhood Experiences and Adult Health and Economic Outcomes

Positive childhood experiences (PCEs) and adverse childhood experiences (ACEs) influence adult health and well-being. While ACEs are linked to chronic disease and poor mental health, PCEs have been shown to build resilience and promote positive outcomes. This study investigates associations between PCEs and adult health and socioeconomic outcomes and whether ACEs moderate these relationships.

We analyzed data from the Behavioral Risk Factor Surveillance Survey from 4 states (2015-2020), including 18 773 adults. PCEs and ACEs were categorized and evaluated against 20 adult health and life opportunity outcomes. Propensity score matching and survey-weighted generalized linear models were used to estimate adjusted prevalence ratios, population attributable fractions, and prevented fractions for the population PFPs.

Reports of PCEs and ACEs were inversely related. Higher PCEs were associated with significantly improved outcomes, including reduced depression, better mental health, and increased income and education, regardless of ACEs. Among those reporting ACEs, adults reporting high PCEs reported lower tobacco use, lower chronic diseases (eg, asthma, diabetes, heart disease), and better general health. PFPs indicated that maximizing PCEs at the population level could theoretically prevent up to 36.5% of depression and 30.7% of poor mental health in adulthood.

PCEs were strongly associated with better adult health and well-being, even in the presence of adversity. ACEs moderated some but not all associations, highlighting the independent protective associations of PCEs. These findings support the potential value of PCEs as a public health strategy to improve long-term outcomes and reduce societal costs.