Abstract C031: The association of adverse childhood experiences (ACEs) and cancer history with resilience: Results from Alabama sites of the RURAL cohort study
Authors: Abraham Stephie , Baumgartner Kathy B. , Baumgartner Richard , Hsu Jesse , Walsh Joanna , Mujahid Mahasin S , Vaccarino Viola , Boone Stephanie 
Published: September 2024

Background: Prior studies have reported a significant association between Adverse Childhood Experiences (ACEs) and various health outcomes, including cancer; however, these have been limited to descriptive and cross-sectional studies. These studies reported that resilience, or the ability to adapt to challenging life experiences, is inversely associated with ACEs and cancer history. To date, there are no studies evaluating the interaction of ACEs and a cancer diagnosis on resilience among adult survivors. The primary aim of this study is to estimate the prevalence of ACEs among RURAL Alabama participants and to determine if the presence of ≥ 4 ACEs and a cancer history influences the odds of reporting self-perceived low and medium (vs. high) resilience compared to those with 0-3 ACEs and no cancer history. Methods: We utilized data from Alabama participants of the RURAL (Risk Underlying Rural Areas Longitudinal) Cohort Study, a prospective study designed to evaluate risk factors for heart and lung disorders in four rural southeastern states. Individuals aged 25-64 years and residents of two counties in Alabama were enrolled and completed a baseline and 3-month follow-up survey. The 30-item Early Trauma Inventory was used to assess the prevalence of ACEs, and the 10-item Connor Davidson-10 Resilience Scale was used to measure self-perceived resilience. Participants were categorized as having high resilience if their total resilience score was ≥75th percentile, medium resilience for scores ≥25th and &lt;75th percentile, and low resilience for scores &lt;25th percentile. Weighted multinomial logistic regression models were used to evaluate the association between number of ACEs (0-3 ACEs vs. ≥ 4 ACEs) and resilience categories and tested interactions between ACEs and cancer history; a p-value &lt;0.05 was considered statistically significant. Results: Of the 556 participants, 38.9% reported having 0-3 ACEs, and 61.1% reported ≥ 4 ACEs. In adjusted models among participants with no cancer history, those experiencing ≥ 4 ACEs had 2.38 times the odds of reporting low (vs. high) resilience (95% CI: 1.93, 2.94) and 1.18 times the odds of reporting medium (vs. high) resilience (95% CI: 1.04, 1.35) compared to those experiencing 0-3 ACEs. Among participants with a cancer history, those experiencing ≥ 4 ACEs had 1.82 times odds of reporting low (vs. high) resilience (95% CI: 1.01, 3.28) and 0.76 times odds of reporting medium (vs. high) resilience (95% CI: 0.49, 1.18) compared to those experiencing 0-3 ACEs. Interactions between ACEs and cancer history were not statistically significant for low and medium (vs. high) resilience (p-values: 0.4 and 0.06, respectively). Conclusion: Those with a cancer history and ≥ 4 ACEs were more likely to report self-perceived low resilience. Significant interactions between ACEs and cancer history were not observed in predicting low and medium resilience (vs. high). To better understand the cumulative effects of ACEs, it is necessary to longitudinally evaluate individuals’ ability to adapt, especially among cancer survivors.

Citation Format: Stephie Abraham, Kathy B. Baumgartner, Richard Baumgartner, Jesse Hsu, Joanna Walsh, Mahasin S Mujahid, Viola Vaccarino, Stephanie Boone. The association of adverse childhood experiences (ACEs) and cancer history with resilience: Results from Alabama sites of the RURAL cohort study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C031.