Background
COVID-19 has created an enormous personal, financial, and psychological burden on families. Emerging studies suggest the pandemic has contributed to an increase in parental mental health challenges and substance use problems. This is the first study to examine the population-level burden of measured adverse childhood experiences (ACEs) pre- and early-onset COVID-19. We hypothesize that ACEs have increased since the pandemic onset, and differentially by type.

Methods
Behavioral Risk Factor Surveillance System is a nationally representative cross-sectional telephone survey using a complex sampling design to capture health-related behaviors and conditions. Data collection spanned January 2019 through April 2020. We compared the prevalence of ACEs and poor mental health days “pre-COVID-19” (January through April 2019) to “early-onset” COVID-19 (January through April 2020) for 17 states using Rao-Scott Chi-Square tests, and corresponding odds ratios and 95% confidence intervals.

Results
Early-onset COVID-19 ACEs ranged from 29.4% for any sexual abuse to 37.0% for emotional abuse. ACEs significantly increased from pre- to early-onset COVID-19 by a factor of 1.11 for emotional abuse, 1.12 for physical abuse, 1.17 for mental illness and 1.21 for sexual abuse. The odds of having a higher number of ACEs increased significantly pre- to early-onset COVID-19 by a factor of 1.11. The odds of having a higher number of poor mental health days significantly increased by a factor of 1.10.

Conclusions
The pandemic has created measurable differences in ACEs in U.S. families. This has profound implications for individual and population health well beyond the end of the pandemic.

Introduction: Adverse childhood experiences (ACEs) have been linked to increased risk for negative health outcomes in adulthood, including cervical cancer. Less is known about the association of ACEs with cancer screening behaviors, which have implications for early detection and treatment. This study examined associations of ACEs with cervical cancer screening.

Methods: We included women 21-65 years old with no history of hysterectomy who participated in the 2012 Behavioral Risk Factor Surveillance System survey (N=7,705). ACE score based on 11 survey questions was categorized (0, 1-3, 4+). The outcomes were defined as ever and recent (within last 3 years) history of Pap test screening. Weighted Poisson regression was used to estimate adjusted relative risk. Effect modification by race/ethnicity was assessed using interaction terms.

Results: 21% of participants reported 4+ ACEs; 96% of participants had history of any Pap test screening and 90% within the last 3 years. Ever screening among women with 4+ ACEs was 5% higher compared to women with 0 ACEs (95%CI: 1.02-1.07, trend p-value < 0.05). Recent screening among women with 4+ ACEs was 4% lower compared to women with 0 ACEs (95%CI: 0.93-0.99, trend p-value < 0.05). The positive association between 4+ ACEs and ever screening was significant for White and Black women but not Hispanic women, while the inverse association between 4+ ACEs and recent screening was significant only for White women.

Conclusion: ACEs are positively associated with ever screening for cervical cancer, but inversely associated with recent screening. These findings may differ by race.