Exploratory Factor Analysis of Adverse Childhood Experiences (ACEs) and Alcohol Misuse among a Nationally Representative Sample of US Adults

Faculty Mentor

Bettye A. Apenteng

Location

Russell Union Ballroom

Type of Research

Completed

Session Format

Poster Presentation

College

Jiann-Ping Hsu College of Public Health

Department

Health Policy and Community Health

Abstract

Background: Alcohol misuse remains a major concern for public health in the U.S. and is consistently linked to adverse childhood experiences (ACEs). ACEs have been linked with adverse health behaviors and outcomes into adulthood, including alcohol and substance use. Most ACE studies treat ACE as a unidimensional domain, which may obscure meaningful heterogeneity in the experience of childhood adversity. This study utilized exploratory factor analysis (EFA) to empirically identify latent ACE sub-domains and examined their associations with adult alcohol misuse.

Methods: We conducted a cross-sectional secondary analysis of 2024 Behavioral Risk Factor Surveillance System (BRFSS) data, focusing on the ACE module. BRFSS reports data on U.S. non-institutionalized adults aged 18 years and older. Thirteen ACE indicators were evaluated using polychoric correlations in an EFA. Multicollinearity diagnostics (correlations, VIF, tolerance) supported factorability; model adequacy was assessed using the Kaiser–Meyer–Olkin (KMO) measure, Bartlett’s test of sphericity, and the correlation matrix determinant. Factor retention was determined using Kaiser eigenvalues >1, the minimum average partial (MAP), and parallel analysis. Derived factor scores were then entered as predictors in Poisson regression models to estimate incidence rate ratios (IRRs) for the maximum number of drinks consumed in the past 30 days.

Results: Diagnostics supported EFA suitability (KMO~0.85; Bartlett’s p< 0.001; determinant non-zero). EFA yielded a three-factor solution with interpretable domains: (1) household dysfunction/substance-related adversity, (2) sexual abuse, and (3) basic needs/safety hardship. In adjusted Poisson models, household dysfunction/substance-related ACEs were the strongest and most consistent predictors of higher maximum drinks, while sexual abuse showed a smaller association and basic needs/safety hardship was not significantly associated.

Conclusions: ACEs are not equally predictive of adult alcohol misuse. Household dysfunction/substance-related adversity appears particularly influential, supporting ACE subtype screening and prevention strategies focused on family instability and household substance use.

Keywords: ACEs, EFA, BRFSS, Alcohol Misuse, Poisson regression

Program Description

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Start Date

4-23-2026 2:00 PM

End Date

4-23-2026 4:00 PM

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Apr 23rd, 2:00 PM Apr 23rd, 4:00 PM

Exploratory Factor Analysis of Adverse Childhood Experiences (ACEs) and Alcohol Misuse among a Nationally Representative Sample of US Adults

Russell Union Ballroom

Background: Alcohol misuse remains a major concern for public health in the U.S. and is consistently linked to adverse childhood experiences (ACEs). ACEs have been linked with adverse health behaviors and outcomes into adulthood, including alcohol and substance use. Most ACE studies treat ACE as a unidimensional domain, which may obscure meaningful heterogeneity in the experience of childhood adversity. This study utilized exploratory factor analysis (EFA) to empirically identify latent ACE sub-domains and examined their associations with adult alcohol misuse.

Methods: We conducted a cross-sectional secondary analysis of 2024 Behavioral Risk Factor Surveillance System (BRFSS) data, focusing on the ACE module. BRFSS reports data on U.S. non-institutionalized adults aged 18 years and older. Thirteen ACE indicators were evaluated using polychoric correlations in an EFA. Multicollinearity diagnostics (correlations, VIF, tolerance) supported factorability; model adequacy was assessed using the Kaiser–Meyer–Olkin (KMO) measure, Bartlett’s test of sphericity, and the correlation matrix determinant. Factor retention was determined using Kaiser eigenvalues >1, the minimum average partial (MAP), and parallel analysis. Derived factor scores were then entered as predictors in Poisson regression models to estimate incidence rate ratios (IRRs) for the maximum number of drinks consumed in the past 30 days.

Results: Diagnostics supported EFA suitability (KMO~0.85; Bartlett’s p< 0.001; determinant non-zero). EFA yielded a three-factor solution with interpretable domains: (1) household dysfunction/substance-related adversity, (2) sexual abuse, and (3) basic needs/safety hardship. In adjusted Poisson models, household dysfunction/substance-related ACEs were the strongest and most consistent predictors of higher maximum drinks, while sexual abuse showed a smaller association and basic needs/safety hardship was not significantly associated.

Conclusions: ACEs are not equally predictive of adult alcohol misuse. Household dysfunction/substance-related adversity appears particularly influential, supporting ACE subtype screening and prevention strategies focused on family instability and household substance use.

Keywords: ACEs, EFA, BRFSS, Alcohol Misuse, Poisson regression