BACKGROUND Experiencing multiple adverse childhood experiences (ACEs) is a risk factor for many adverse outcomes. We explore associations of ACEs with educational attainment and adolescent health and the role of family and socioeconomic factors in these associations. METHODS AND FINDINGS Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort of children born in southwest England in 1991-1992, we assess associations of ACEs between birth and 16 years (sexual, physical, or emotional abuse; emotional neglect; parental substance abuse; parental mental illness or suicide attempt; violence between parents; parental separation; bullying; and parental criminal conviction, with data collected on multiple occasions between birth and age 16) with educational attainment at 16 years (n = 9,959) and health at age 17 years (depression, obesity, harmful alcohol use, smoking, and illicit drug use; n = 4,917). We explore the extent to which associations are robust to adjustment for family and socioeconomic factors (home ownership, mother and partner's highest educational qualification, household social class, parity, child's ethnicity, mother's age, mother's marital status, mother's depression score at 18 and 32 weeks gestation, and mother's partner's depression score at 18 weeks gestation) and whether associations differ according to socioeconomic factors, and we estimate the proportion of adverse educational and health outcomes attributable to ACEs or family or socioeconomic measures. Among the 9,959 participants (49.5% female) included in analysis of educational outcomes, 84% reported at least one ACE, 24% reported 4 or more ACEs, and 54.5% received 5 or more General Certificates of Secondary Education (GCSEs) at grade C or above, including English and Maths. Among the 4,917 participants (50.1% female) included in analysis of health outcomes, 7.3% were obese, 8.7% had depression, 19.5% reported smoking, 16.1% reported drug use, and 10.9% reported harmful alcohol use. There were associations of ACEs with lower educational attainment and higher risk of depression, drug use, and smoking. For example, odds ratios (ORs) for 4+ ACEs compared with no ACEs after adjustment for confounders were depression, 2.4 (1.6-3.8, p < 0.001); drug use, 3.1 (2.1-4.4, p < 0.001); and smoking, 2.3 (1.7-3.1, p < 0.001). Associations with educational attainment attenuated after adjustment but remained strong; for example, the OR after adjustment for confounders for low educational attainment comparing 4+ ACEs with no ACEs was 2.0 (1.7-2.4, p < 0.001). Associations with depression, drug use, and smoking were not altered by adjustment. Associations of ACEs with harmful alcohol use and obesity were weak. For example, ORs for 4+ ACEs compared with no ACEs after adjustment for confounders were harmful alcohol use, 1.4 (0.9-2.0, p = 0.10) and obesity, 1.4 (0.9-2.2, p = 0.13) We found no evidence that socioeconomic factors modified the associations of ACEs with educational or health outcomes. Population attributable fractions (PAFs) for the adverse educational and health outcomes range from 5%-15% for 4+ ACEs and 1%-19% for low maternal education. Using data from multiple questionnaires across a long period of time enabled us to capture a detailed picture of the cohort members' experience of ACEs; however, a limitation of our study is that this resulted in a high proportion of missing data, and our analyses assume data are missing at random. CONCLUSIONS This study demonstrates associations between ACEs and lower educational attainment and higher risks of depression, drug use, and smoking that remain after adjustment for family and socioeconomic factors. The low PAFs for both ACEs and socioeconomic factors imply that interventions that focus solely on ACEs or solely on socioeconomic deprivation, whilst beneficial, would miss most cases of adverse educational and health outcomes. This interpretation suggests that intervention strategies should target a wide range of relevant factors, including ACEs, socioeconomic deprivation, parental substance use, and mental health.

中文翻译：

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不良童年经历与受教育程度和青少年健康的关联以及家庭和社会经济因素的作用：英国的一项前瞻性队列研究。

背景 经历多种童年不良经历 (ACE) 是许多不良后果的危险因素。我们探讨了 ACE 与受教育程度和青少年健康的关联，以及家庭和社会经济因素在这些关联中的作用。方法和发现 我们使用来自雅芳父母和儿童纵向研究 (ALSPAC) 的数据，该队列是 1991 年至 1992 年在英格兰西南部出生的前瞻性儿童队列，我们​​评估了 ACE 在出生和 16 岁之间的关联（性虐待、身体虐待或情感虐待） ；情感忽视；父母药物滥用；父母精神疾病或自杀未遂；父母之间的暴力行为；父母分居；欺凌；以及父母刑事定罪，在出生和 16 岁之间多次收集数据）以及 16 岁时的教育程度（n = 9、959) 和 17 岁时的健康状况（抑郁、肥胖、有害饮酒、吸烟和非法药物使用；n = 4,917）。我们探讨了关联对调整家庭和社会经济因素（房屋所有权、母亲和伴侣的最高学历、家庭社会阶层、奇偶校验、孩子的种族、母亲的年龄、母亲的婚姻状况、母亲的抑郁评分为 18 和 32）的稳健程度周妊娠和母亲伴侣在妊娠 18 周时的抑郁评分）以及关联是否因社会经济因素而异，我们估计了可归因于 ACE 或家庭或社会经济措施的不良教育和健康结果的比例。在纳入教育成果分析的 9,959 名参与者（49.5% 为女性）中，84% 的人至少报告了一项 ACE，24% 的学生获得了 4 个或更多的 ACE，54.​​5% 的学生获得了 5 个或更多的 C 级或以上的普通中等教育证书 (GCSE)，包括英语和数学。在纳入健康结果分析的 4,917 名参与者（50.1% 为女性）中，7.3% 肥胖，8.7% 抑郁，19.5% 吸烟，16.1% 吸毒，10.9% 有害饮酒。ACEs 与较低的教育程度和较高的抑郁、吸毒和吸烟风险有关。例如，在调整混杂因素后，4+ ACE 与无 ACE 的比值比 (OR) 为抑郁症，2.4 (1.6-3.8, p < 0.001)；药物使用，3.1（2.1-4.4，p < 0.001）；和吸烟，2.3 (1.7-3.1, p < 0.001)。与受教育程度的关联在调整后有所减弱，但仍然很强；例如，比较 4+ ACE 与无 ACE 的低教育程度混杂因素调整后的 OR 为 2.0 (1.7-2.4，p < 0.001)。与抑郁症、吸毒和吸烟的关联并未因调整而改变。ACEs 与有害饮酒和肥胖的关联很弱。例如，在针对混杂因素进行调整后，4+ ACE 与无 ACE 的 OR 分别为有害饮酒 1.4 (0.9-2.0, p = 0.10) 和肥胖 1.4 (0.9-2.2, p = 0.13) 我们没有发现任何证据表明社会经济因素改变了 ACE 与教育或健康结果的关联。不良教育和健康结果的人口归因分数 (PAF) 范围为 4+ ACE 的 5%-15% 和低孕产妇教育的 1%-19%。通过长期使用来自多个问卷的数据，我们能够详细了解队列成员的 ACE 体验；然而，我们研究的局限性在于这导致了高比例的数据缺失，并且我们的分析假设数据是随机缺失的。结论 本研究表明，在针对家庭和社会经济因素进行调整后，ACE 与较低的教育程度以及较高的抑郁、吸毒和吸烟风险之间存在关联。ACE 和社会经济因素的低 PAF 意味着仅关注 ACE 或仅关注社会经济剥夺的干预措施虽然有益，但会遗漏大多数不利的教育和健康结果。这种解释表明，干预策略应针对广泛的相关因素，