142nd APHA Annual Meeting and Exposition

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306893
Adverse Childhood Experiences and HIV/STIs: A Mediational Analysis

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Monique J. Brown, MPH , Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond, VA
Saba Masho, MD, MPH, DrPH , Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA
Briana Mezuk, PhD , Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond, VA
River Pugsley, PhD, MPH , Division of Disease Prevention, Virginia Department of Health, Richmond, VA
Robert Perera, PhD , Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA
Steven A. Cohen, DrPH, MPH , Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA
Background: Approximately 63% of the general US population has been exposed to adverse childhood experiences (ACEs), including emotional, physical or sexual abuse, witnessing parental violence, or living with someone who has mental illness, a substance abuse (SA) or incarceration history.  ACEs have been linked to violence, psychopathology, and sexually transmitted infections (STIs).  However, the mediational pathways for these relationships are not understood. 

Objective: To determine the mediational role of posttraumatic stress disorder (PTSD), SA, depression, age at sexual debut, and intimate partner violence (IPV) perpetration in the association between ACEs and HIV/STIs.

Methods: Data were obtained from the National Epidemiologic Survey on Alcohol Related Conditions (2004-2005) (N=34,653).  Exploratory factor analysis (EFA) was used to determine latent factors for ACEs, and IPV perpetration.  Mediation analysis was used to determine the mediational roles of PTSD, SA, depression, age at sexual debut, and IPV perpetration in the association between ACEs and past year HIV/STIs in five separate models. 

Results: EFA of ACEs produced three factors: sexual abuse, neglect/other abuse, and parental psychopathology.  SA partially mediated the association between all three factors and HIV/STIs: sexual abuse (p=0.011), neglect/other abuse (p=0.007), and parental psychopathology (p=0.001).  IPV perpetration partially mediated the association between two ACE factors and HIV/STIs: neglect/other abuse (p=0.007), and parental psychopathology (p=0.001).  PTSD, depression, and age at sexual debut were not found to be statistically significant mediators.

Conclusions: HIV/STI intervention/prevention programs should consider addressing ACEs, which have far-reaching effects across the lifespan, along with SA and IPV perpetration as additional key focal points.

Learning Areas:

Epidemiology
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess the association between adverse childhood experiences and past year HIV/STI diagnosis Identify mediators in the association between adverse childhood experiences and past year HIV/STI diagnosis Compare different mediational models examining the link between adverse childhood experiences and past year HIV/STI diagnosis

Keyword(s): Behavioral Research, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral candidate in the PhD in Epidemiology program in the Department of Family Medicine and Population Health at the Virginia Commonwealth University School of Medicine. I have completed extensive coursework in epidemiology and biostatistics methods. I have published prior research and have presented at national conferences on adverse childhood experiences. I am first author on a manuscript under review focusing on the association between meeting sex partners online and STI history.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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