(PS4-C71) Confirmatory Factor Analysis of the Behavioral Risk Factor Surveillance System’s 2021 ACE Module

Adverse childhood experiences (ACEs) are commonly conceptualized as very negative and detrimental life events that individuals may experience prior to the age of 18. Exposure to ACEs has been found to be associated with a wide variety of negative health (e.g., heart disease, premature death) and psychosocial outcomes (e.g., depression, substance abuse) in adulthood (e.g., Felitti et al., 1998). Additionally, increased numbers of exposure to distinct categories of ACEs (e.g., physical abuse, household mental illness) has been shown to have increasingly deleterious effects, such that an individual who has experienced greater numbers of domains of ACEs is predicted to have worse outcomes in adulthood. In addition to research that investigates the effects of the total number of ACEs experienced, some research (e.g., Ford et al., 2014) has investigated larger groupings of ACEs to further our understanding of how different types of ACEs may be differentially related to later negative outcomes. The current study seeks to build on previous literature by utilizing items that were newly added to the Behavioral Risk Factor Surveillance System (BRFSS)’s ACE module that assess emotional and physical neglect, in order to determine if these items fit into a previously identified factor structure of the BRFSS ACE items.

Participants included 57,985 individuals who responded to Adverse Childhood Experiences Optional Module of the Centers for Disease Control and Prevention's 2021 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit-dialed national phone survey. This sample was 55.1% female, 79.0% White (n = 45,837), and 57.9% were under the age of 65. The Adverse Childhood Experiences Module includes 13 items that assess for experience of 11 ACE domains: household mental illness, household alcohol abuse, household substance use, parental incarceration, parental divorce, domestic violence, physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. The items assessing physical and emotional neglect were first introduced in the 2021 BRFSS, while the remaining items have been used yearly since 2009. Based on previous factor analyses investigating the factor structure of the BRFSS ACE Module (Ford et al., 2014), a three-factor model was tested including the following factors: Abuse and Neglect, Household Dysfunction, and Sexual Abuse. All items significantly loaded on to their assigned factors; however, given that the parental divorce item loaded relatively poorly on to the Household Dysfunction factor (factor loading = 0.606), it was removed from further analyses. All other factor loadings were greater than 0.700. Model fit was assessed using the RMSEA (0.045), CFI (0.980), and TLI (0.975), all of which indicated good model fit. These results suggest that the newly included items assessing exposure to neglect fit well into previously identified factor structures. Limitations and implications related to greater theoretical understanding of ACE as a construct and applied utility of calculation of ACE domain scores will also be presented.