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PEDIATRICS Vol. 106 No. 1 July 2000, p. e11

ELECTRONIC ARTICLE:
Adverse Childhood Experiences and Sexually Transmitted Diseases in Men and Women: A Retrospective Study

Received Aug 3, 1999; accepted Feb 4, 2000.

Susan D. Hillis*, Robert F. Anda*, Vincent J. FelittiDagger , Dale Nordenberg§, and Polly A. Marchbanks*

From the * National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Dagger  Department of Preventive Medicine, Southern California Permanente Medical Group (Kaiser Permanente), San Diego, California; and § Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.

Objective.  Adverse childhood experiences (ACEs) may have long-term consequences on at-risk behaviors that lead to an increased risk of sexually transmitted diseases (STDs) during adulthood. Therefore, we examined the relationship between ACEs and subsequent STDs for both men and women.

Methods.  A total of 9323 (4263 men and 5060 women) adults >= 18 years of age participated in a retrospective cohort study evaluating the association between ACEs and self-reported STDs. Participants were adult members of a managed care organization who underwent routine medical evaluations and completed standardized questionnaires about 7 categories of ACEs, including emotional, physical, or sexual abuse; living with a battered mother; and living with a substance-abusing, mentally ill, or criminal household member. Logistic regression was used to model the association between the cumulative categories of ACEs (range: 0-7) and a history of STDs.

Results.  We found that 59% (2986) of women and 57% (2464) of men reported 1 or more categories of adverse experiences during childhood. Among those with 0, 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the proportion with STDs was 4.1%, 6.9%, 8.0%, 11.6%, 13.5%, and 20.7% for women and 7.3%, 10.9%, 12.9%, 17.1%, 17.1%, and 39.1% for men. After adjustment for age and race, all odds ratios for reporting an STD had confidence intervals that excluded 1. Among those with 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the odds ratios were 1.45, 1.54, 2.22, 2.48, and 3.40 for women and 1.46, 1.67, 2.16, 2.07, and 5.3 for men.

Conclusions.  We observed a strong graded relationship between ACEs and a self-reported history of STDs among adults.  Key words:  sexually transmitted diseases, child abuse, domestic violence, alcoholism, children of impaired parents, drug abuse.




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