Relationship between Adverse Childhood Experiences and Resiliency among College Students

Glory Okwori


Background: Adverse childhood experiences (ACEs) are associated with negative outcomes, however, there are factors that can mitigate the effects from exposure to ACEs. This study examined the prevalence of adverse childhood experiences (ACEs), characteristics of resilient individuals and the association between ACE scores, resiliency and other factors among college students.    

Subjects and Method: A cross-sectional survey was completed in 2018. Frequencies were calculated for the number and types of ACE experienced by participants. Bivariate relationships between characteristics of parti­cipants and resilience were examined using Chi-square tests.  The independent relationship between ACE scores and resiliency factors was examined using ordinal logistic regression. The dependent variable was ACE score. An ordinal logistic regression model examined the relati­onship between conventional ACE scores and resilience levels and other factors.

Results: There were 570 study participants. Seventy-one percent of study participants had experienced at least one conventional ACE, and 98% had experienced at least one expanded ACE. Individuals with high resilience had lower conventional ACE scores and better health. Females (OR= 1.67; 95% CI= 1.14 to 2.45) were more likely to have higher conventional ACE scores. Participants living in suburban areas compared to rural areas (OR= 0.61; 95% CI: 0.43 to 0.85), and children raised with both parents compared to single parents (OR= 0.17; 95% CI= 0.12 to 0.25) were less likely to have higher conventional ACE scores. Gender (OR= 0.54; 95% CI= 0.35 to 0.82) and general health status (OR= 1.50; 95% CI= 1.05 to 2.13) were the only significant predictors of the expanded ACE scores.

Conclusion: Findings identify important resilient traits such as relationships, self-control, internal beliefs, and initiative,. as well asportray the high prevalence ofACEs and the importance of resilience as a protective factor in reducing ACEs.

Keywords: adverse childhood experiences, resilience, mitigate 

CorrespondenceGlory Okwori. East Tennessee State University. 1276 Gilbreath Dr., Box 70300, Johnson City, TN. Email:

Journal of Epidemiology and Public Health (2021), 06(01): 83-97­/jepublic­health.2021.06.01.09


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Ananth C, Kleinbaum DG (1997). Regression models for ordinal responses: a review of methods and applications. Int J Epidemiol. 26(6): 1323–1333. Available at: (Accessed: 20 June 2020).

Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, Williamson DF, Giovino GA (1999). Adverse childhood experiences and smoking during adolescence and adulthood. J Am Med Assoc. 282(17): 1652–1658.

Arnett JJ (2019) Emerging adulthood: the winding road from the late teens through the twenties. 2nd edn. Oxford University Press.

Balistreri KS, Alvira-Hammond M (2016). Adverse childhood experiences, family functioning and adolescent health and emotional wellbeing. Public Health. 132: 72–78. doi: 10.1016/j.puhe.2015.10.034.

Ball A, Mackrain M (2008) Devereux Adult Resilience Survey (DARS), Professional Psychology Trainee. Available at:

Belanger K, Benson W, Borders T, Dalton K, Emanuel-McClain C, Evans K, Fabre B, et al. (2018). Exploring the rural context for adverse childhood experiences (ACEs). National Advisory Committee on Rural Health and Human Services. https://www.hrsa.-gov/sites/default/files/hrsa/advisorycommittees/rural/publications/Rural-Context-for-ACEs-August201.pdf.

Bellis MA, Hughes K, Ford K, Hardcastle KA, Sharp CA, Wood S, Homolova, L Davies A (2018). Adverse childhood experiences and sources of childhood resilience: A retrospective study of their combined relationships with child health and educational attendance.

BMC Public Health. 18(1).

Bethell CD, Newacheck P, Hawes E, Halfon N (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Aff. 33(12): 2106–2115.

Bramlett M, Radel LF (2014) Adverse family experiences among children in nonparental care, 2011-2012. Natl Health Stat Report. Available at: (Accessed: 16 June 2020).

Brogden L, Gregory DE (2019). Resilience in community college students with adverse childhood experiences. Community Coll J Res Prac. 43(2): 94–108. doi: 10.1080/10668926.2017.14-18685.

Center on the Developing Child at Harvard University (2016) From Best Practices to Breakthrough Impacts - Center on the Developing Child at Harvard University. Available at: 16 June 2020).

Centers for Disease Control and Prevention (2010) Adverse childhood experiences reported by adults Five States, 2009, 2010. Available at: (Accessed: 21 June 2020).

Chanlongbutra A, Singh GK, Mueller CD (2018). Adverse childhood experiences, health related quality of life, and chronic disease risks in rural areas of the United States. J Environ Public Health. 2018: 7151297.

Cronholm PF, Forke CM, Wade R, Bair-Merritt MH, Davis M, Harkins-Schwarz M, Pachter LM, Fein JA (2015). Adverse childhood experiences: Expanding the concept of adversity. Am J Prev Med. 49(3): 354–361.

Crouch E, Strompolis M, Radcliff E, Srivastav A (2018). Examining exposure to adverse childhood experiences and later outcomes of poor physical and mental health among South Carolina adults. Children and Youth Services Review. 84: 193–197.

Danese A, Moffitt TE, Harrington HL, Milne BJ, Polanczyk G, Pariante CM, Poulton R, Caspi A (2009). Adverse childhood experiences and adult risk factors for agerelated disease: Depression, inflammation, and clustering of metabolic risk markers.Arch Pediatr Adolesc Med. 163(12): 1135–1143.

Davidovich S, Collishaw S, Thapar AK, Harold G, Thapar A, Rice F (2016). Do better executive functions buffer the effect of current parental depression on adolescent depressive symptoms?. J Affect Disord. 199: 54–64.

Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the adverse childhood experiences study. J Am Med Assoc, 286(24):3089–3096.

Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB (2002). Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav. 27(5): 713–725.

Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics. 111(3): 564–572.

Dube SR, Williamson DF, Thompson T, Felitti VJ, Anda RF (2004). Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse Negl. 28(7): 729–737.

Edwards V, Anda RF, Gu D, Dube SR, Felitti VJ (2007). Adverse childhood experiences and smoking persistence in adults with smokingrelated symptoms and illness. Perm J. 11(2): 5-13.

El-Masri MM, Fox-Wasylyshyn SM (2005). Missing data: An introductory conceptual overview for the novice researcher. Can J Nursing Res. 37(4): 156–171.

Fan Y, Chen Q (2012). Family functioning as a mediator between neighborhood conditions and children’s health: Evidence from a national survey in the United States. Soc Sci Med. 74(12): 1939–1947.

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. Am J Prev Med. 14(4): 245–258.

Felitti VJ, Anda RF (2010). The relation-ship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic.Cambridge University Press. 77–87.

Fuller-Thomson E, Brennenstuhl S (2009). Making a link between childhood physical abuse and cancer. Cancer. 115(14): 3341–3350.

Gartland D, Riggs E, Muyeen S, Giallo R, Afifi TO, MacMillan H, Herrman H, Bulford E, Brown SJ (2019). What factors are associated with resilient outcomes in children exposed to social adversity? A systematic review. BMJ Open. 9(4): e024870.

Howell KH, Miller-Graff LE (2014). Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence. Child Abuse and Neglect. 38(12): 1985–1994.

Khrapatina I, Berman P (2017). The impact of adverse childhood experiences on health in college students. J Child Adoles Trauma. 10(3): 275–287.

Lall R, Campbell MJ, Walters SJ, Morgan K (2002). A review of ordinal regression models applied on health-related quality of life assessments. Stat Methods Med Res. 11(1):49-67.

Liu M, Mejia-Lancheros C, Lachaud J, Nisenbaum R, Stergiopoulos V, Hwang SW (2020). Resilience and adverse childhood experiences: Associations with poor mental health among homeless adults. Am J Prev Med. 58(6): 807–816.

Mackrain M (2013) Devereux Adult Resi-lience Survey (DARS). Available at:

Masten AS, Tellegen A (2012). Resilience in developmental psychopathology: Contributions of the Project Competence Longitudinal Study. Dev Psychopathol. 24(2): 345–361.

McEwen CA, Gregerson SF (2019). A critical assessment of the adverse childhood experiences study at 20 years. Am J Prev Med. 56(6): 790–794.

Murray DW, Rosanbalm K, Christopoulos C (2016). Selfregulation and toxic stress report 3: A comprehensive review of selfregulation interventions from birth through young adulthood. FPG Child Development Institute. Washington, DC. Available at:

(Accessed: 7 July 2020).

Narayan AJ, Rivera LM, Bernstein RE, Harris WW, Lieberman AF (2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale.Child Abuse and Negl. 78: 19–30.

National Scientific Council on the Developing Child (2015). Supportive relationships and active skill building strengthen the foundations of resilience. Available at:

O’Connell A (2011). The cumulative (proportional) odds model for ordinal outcomes’, in logistic regression models for ordinal response variables. SAGE Publications. 28–54.

Pérez-Zepeda MU, Belanger E, Zunzunegui MV, Phillips S, Ylli A, Guralnik J (2016). Assessing the validity of selfrated health with the short physical performance battery: Acrosssectional analysis of the international mobility in aging study. PLoS ONE. 11(4): e01-53855.

Schafer JL (1999). Multiple imputation: a primer. Stat Methods Med Res. 8(1): 3-15.

Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Am Academy of Pediatrics, 129(1): e232–e246.

Smith BW, Epstein EM, Ortiz JA, Christo-pher PJ, Tooley EM (2013). In: Prince-Embury S, Saklofske D. (eds) Resilience in Children, Adolescents, and Adults. The Springer Series on Human Exceptionality. Springer, New York, NY.

Talbot JA, Szlosek D, Ziller EC (no date) Adverse Childhood Experiences in Rural and Urban Contexts. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

Traub F, Boynton-Jarrett R (2017). Modifiable resilience factors to childhood adversity for clinical pediatric practice. Pediatrics. 139(5): e20162569

Young-Wolff KC, Alabaster A, McCaw B, Stoller N, Watson C, Sterling S, Rid-out KK, Flanagan T (2019). Adverse childhood experiences and mental and behavioral health conditions during pregnancy: The role of resi-lience. J Womens Health (Larchmt). 28(4):452–461.


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