Adverse Childhood Experiences and the Association with Childhood Obesity: A Cross-Sectional Study of the U.S. National Survey of Children’s Health (NSCH), 2011-2012.

INTRODUCTION: Studies on the topic of adverse childhood experiences (ACEs) and childhood obesity collectively indicate an association, but there is a lack of replication in nationally representative sample of children aged 10-17 years. This study aims to expand on the definition of ACEs to include: socio-economic hardship, racial discrimination, witness or victim of neighborhood violence, and bereavement, and to examine their individual and joint association with BMI levels, especially childhood obesity (primary outcome). METHODS: The 2011-2012 National of Children’s Health (NSCH) was used for this study (N=45,309). One child interview weight was produced; hence, the estimates are generalized to all non-institutionalized children 10-17 years of age in the US and each state. Statistical methods used included descriptive statistics and multivariable multinomial logistic regression models. ACEs examined included: (1) Socioeconomic hardship, (2) Parental divorce or separation, (3) Bereavement, (4) Incarcerated family member, (5) Witness to domestic violence, (6) Victim/witness of neighborhood violence, (7) Household mental illness, (8) Household substance abuse, (9) Racial discrimination. BMI for the same sex and age (10-17 years) percentile relative measurement, using growth charts recommended by CDC, among children and teens were used as indicators of BMI. BMI-95th percentile or greater was considered obese. RESULTS: The prevalence of childhood obesity and ACE exposure was higher for boys compared to girls. Controlling for gender, among those who were obese, White-nonHispanic children had the highest prevalence of obesity compared to other races for both genders. Southern States constituted 80% and 60 % of top 10 states with the highest prevalence of childhood obesity and ACE, respectively. Approximately 25.4 million (89.5%) children aged 10-17 years had experienced 3 or less ACE. The most prevalent ACE category of nine asked about for child was-living with parents who were either divorced or separated after his/her birth (26.77%) andthe least prevalent was living with a parent who died (4.84 %). ACEs were not mutually exclusive, and all nine categories of ACEs were interrelated. The adjusted odds ratio of covariates to their reference groups that were only statistically significant for childhood obesity relative to healthy weight encompassed: a) Place of residence in metropolitan statistical area, b) two or more chronic health conditions of 18 asked about, c) Watching TV, videos, or playing video games across categories >1 to <4 hours and ≥4 hours, d) family members in the household eat a meal together 7 days of the week, e) and computer, cell phone or electronic device use ≤1 hour. Moreover, the explanatory variables, namely, age, sex, physical health status of parents, and physical activity, were strongly related to childhood obesity (associated both with higher odds and lower odds of outcome) compared to overweight and underweight BMI categories. CONCLUSIONS: This is the first study to explore the co-occurrence, individual and joint association of ACEs with childhood obesity using nationally representative sample of children aged10-17 years in the U.S. Having childhood obesity, BMI-95th percentile or above was strongly related to ACE dichotomy, ACE score ≥2 and two ACE types (socioeconomic hardship and bereavement) than the probability of overweight, BMI85th to 94th percentile. Underweight-BMI less than 5th percentile had only statistically significant association with socioeconomic hardship ACE category. Sociodemographic, parental, and childhood related factors were also independently associated with childhood obesity.