Adverse Childhood Experiences (ACEs) and Adolescent Reproductive Health: Differentiating Household and Community Adversity.

Purpose: To add to existing knowledge on relationships between Conventionally-identified Adverse Childhood Experiences (ACEs) and adolescent reproductive health (ARH) outcomes, we identified contributions of Expanded (community-level) ACEs, integrating measures of ACE co-occurrence and burden.

Methods: Secondary analysis of 2012-2013 Philadelphia ACEs data from a population-based adult sample. Weighted regressions, adjusted for age, sex, race/ethnicity, and socioeconomic status, tested associations between Conventional and Expanded ACEs (separately and co-occurring) and ACE burden (lowest to highest exposure) with: early sexarche (<15 years), adolescent pregnancy (<19 years), and unintended adolescent pregnancy.

Results: Conventional ACEs showed strong dose-response relationships with all outcomes (aOR range: 2.04-4.96, p<0.05). Expanded ACEs were associated with early sexarche (aOR=2.50; 95%CI: 1.27, 4.94), adolescent pregnancy (aOR=1.69; 95%CI: 1.16, 2.46), and unintended adolescent pregnancy (aOR=1.54; 95%CI: 1.04, 2.29); dose-response patterns were inconsistent. Co-occurring Conventional and Expanded ACEs produced the greatest odds for all outcomes except early sexarche (aOR range: 3.20-14.97, p<0.05).

Conclusions: Conventional and Expanded ACEs are important independently and jointly. ARH outcomes peaked when Conventional and Expanded ACEs co-occurred and both exposures were high. Results suggest that Conventional ACEs may be overestimated when assessed in isolation, highlighting the importance of considering Expanded ACEs to minimize bias and target appropriate interventions.