• Paige K Lombard, Peter F Cronholm, and Christine M Forke.
• Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Barbara and Edward Netter Center for Community Partnerships, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: plombard@sas.upenn.edu.
• Am J Prev Med. 2022 Jun 1; 62 (6): e357-e365.

IntroductionThe Behavioral Risk Factor Surveillance System is a national health-related survey with an optional adverse childhood experience (ACE) module. States use varying methodologies, question formats, and sampling frames, and little guidance exists for conducting multistate explorations of adverse childhood experiences. In this study, 6 adverse childhood experience scoring approaches are compared, and practical recommendations are offered for when and how each approach can be utilized most effectively.MethodsThis study used 2015 Behavioral Risk Factor Surveillance System data from the adverse childhood experience module administered by 6 states. Data were merged and analyzed between 2018 and 2021. To understand how adverse childhood experience scoring may impact estimates of association, concordance/discordance among 6 approaches (continuous versus categorical, states that collected all adverse childhood experiences versus those that collected any adverse childhood experiences, and normalized versus standard scores) was evaluated. Using separate weighted multivariable logistic regression models controlling for confounders, the relationship between adverse childhood experiences using each approach and the presence of 10 chronic health conditions was also assessed.ResultsComparisons revealed discordance for categorical versus continuous approaches (30%) and all-ACEs versus any-ACEs (20%) but full concordance for standard versus normalized approaches. Discordance occurred more frequently with low-prevalence outcomes (≤7.0%) and lower-exposure samples (any-ACEs).ConclusionsResults revealed general concordance across adverse childhood experience scoring approaches when outcomes commonly occurred and when the sample was limited to just states that asked the full array of adverse childhood experiences. However, on a deeper exploration of discordant findings, specific nuances were uncovered that may help guide researchers when deciding on which approach to use on the basis of the research question and conceptual model driving study objectives.Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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