Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Linda Mayes


Background/Rationale Adverse childhood experiences (ACE) and their lasting sequelae are a significant public health concern. ACEs are a risk factor for increased risk of detrimental health behaviors, chronic disease morbidity, and mortality. Though this connection has been supported by an abundance of evidence, how best to address these issues in practice and in the community has yet to be confirmed. Prior research examining the health promoting factors exhibited by adults who have experienced several different ACEs yet have experienced few negative health outcomes, have identified social support, education, and physical activity as potentially protective factors. This study seeks to identify factors associated with improved health during childhood that may have the potential to prevent future poor outcomes.

Methods Multivariate analyses of child and family factors and their association with emotional and behavioral problems (EBD), BMI, resilience and their interactions with ACEs were carried out using data from the 2011-2012 National Survey of Children’s Health. The 2011-2012 NSCH is a cross-sectional survey of the general population of children living in the United States.

Results Resilience was associated 70% lowered odds of EBD (p<0.001), but was not associated with BMI outcomes after adjustment (p-0.311). Children who participated in organized sports were 1.27 (95%CI: 1.07, 1.49) times as likely to demonstrate resilience, 0.69 (95%CI: 0.58, 0.81) and 0.80 (95%CI: 0.68,0.94) times as likely to have a diagnosed EBD or have a BMI above the 85th percentile, respectively. Among children aged 2-5, those that played with other children at least 4 times per week had 0.65 (0.44, 0.97) times the odds of EBD compared to those that did not. Only parental social support was found to significantly weaken the relationship between cumulative ACE scores and EBD outcomes (p-0.001).

Discussion This investigation identified several significant associations that are associated with better health and behavioral outcomes among all children and those exposed to high ACEs. However, the cross-sectional nature of this study limits the assertion that these factors have the potential to provide protective benefits. More long-term longitudinal studies on young children are needed to confirm these findings and better characterize their relationship with resilience and improved outcomes.


This is an Open Access Thesis.

Open Access

This Article is Open Access