Data and sample
Data were obtained from the Well-Being and Experiences (WE) Study, which involved a baseline survey of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada. Two parents did not complete the survey, which is why the adolescent and parent sample sizes differ. Since the adolescent and parent data were not linked, the additional adolescents were included in this analysis. The sampling design for the WE Study used random digit dialing (21%) and convenience sampling (79%) such as referrals, and community advertisements. From the random digit dialing portion of the sample, 83% were interested in participating in the study and 17% refused to participate. Of the 83, 97% were ineligible because an adolescent aged 14 to 17 years old did not live in the household. Of those who were eligible, 63% consented and completed the survey. Differences in the distribution of the data were not found based on sample method for age, grade, ethnicity, emotional abuse, emotional neglect, exposure to verbal IPV, household substance use, household mental illness, parental trouble with police, parental gambling, foster care or child protective organization [CPO], poverty, and neighbourhood safety. The Forward Sortation Area (FSA) from postal codes was used to ensure the sample was closely representative of Winnipeg, Manitoba, the largest city in the province with a population of approximately 753,700 and surrounding rural areas. Data collection was monitored to ensure that the adolescent sample closely approximated the general population with regard to sex (adolescents), household income, and ethnicity, following the Statistics Canada (2017) census profile. As with other studies using similar designs, the person most knowledgeable of the adolescent was asked to complete the survey . In the majority of cases, the person most knowledgeable was the mother. This means that our adult sample is mostly women and, therefore, the parent sample is not representative of the general population. Data were collected between July 2017 and October 2018. Parents and adolescents self-completed a questionnaire at a research facility in private separate rooms. Parents did not have access to adolescent responses. All respondents provided informed consent to participate and were aware that they could withdraw from the study at any time. Parents and adolescents were compensated $50 and $30, respectively for their time and travel expenses. Ethical approval was provided from the Health Research Ethics Board at the University of Manitoba.
Adverse childhood experiences (ACEs)
Original ACEs. For parents, all 10 original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to IPV, household substance abuse, household mental illness, parental separation or divorce, and parental trouble with police) that they experienced in their own childhood were assessed in the sample. However, not all constructs were measured using the ACEs checklist. Rather, more detailed assessments of these experiences were used when available. Childhood physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect were measured using the Childhood Trauma Questionnaire,  which included five items for each of the following: physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. These items asked about the parents’ experiences when growing up and were dichotomized as recommended by the guidelines for classification of the CTQ scale total scores . Exposure to physical IPV was assessed using an adapted item from the Childhood Experiences of Violence Questionnaire (CEVQ) asking the respondents if, before age 16 years, they heard a parent, step-parent or guardian hit each other or another adult in their home . The remaining four ACEs were from the ACEs Study or adapted from the ACEs Study . More specifically, household substance abuse was assessed with two items asking if, before age 16, a parent or other adult living in their home ever had problems with 1) alcohol or spent a lot of time drinking or being hung over and 2) drugs. Household mental illness was assessed by asking if, before age 16, a parent or other adult living in their home ever had mental health problems like depression or anxiety. Parental separation or divorce was assessed by asking if their biological parents were ever separated or divorced before the respondent was 16 years old. Finally, rather than asking about parental incarceration, respondents were asked if, before age 16 years, a parent or other adult living in their home ever had problems with the police.
For adolescents, seven of the original ACEs were asked, excluding physical abuse, sexual abuse, and physical neglect due to the reporting laws for this age group since the WE Study data were not anonymously collected. Emotional neglect was measured using five items from the CTQ subscale and modified to the present tense . Emotional abuse was assessed with one item asking how many times in the past 12 months a parent or other adult living in their home said hurtful or mean things to the respondent. Emotional abuse was dichotomized as once a month or more often versus several times a year or less often. Exposure to verbal IPV was assessed using one item from the CEVQ asking how often in the past 12 months the respondent has ever seen or heard adults say hurtful or mean things to another adult in their home . Exposure to verbal IPV was also dichotomized as once a month or more often versus several times a year or less often. The remaining original ACEs (i.e., household substance use, household mental disorders, parental separation or divorce, and parental trouble with police) were all assessed with the same items used in the adult sample indicated above.
Potential Expanded ACEs.
Spanking. Parents and adolescents were asked how often they remember being spanked by an adult (or parent or caregiver) in a typical year when they were 10 years old or younger, using an item adapted from the CEVQ . Spanking was dichotomized as two to three times a year or more frequently versus once a year or less frequently.
Parental gambling. Parents and adolescents were asked whether a parent or other adult living in the home ever had problems with gambling. For parents in the sample, this question referred to when they were younger than 16 years. Gambling was dichotomized as yes versus no.
Foster Care or Child Protective Organization (CPO) contact. Both parents and adolescents were asked about contact with a CPO (e.g., social services, child welfare, children’s aid, or the Ministry) due to difficulties in the home (for parents, before they were 16 years). In addition, adolescents in the sample were asked if they had ever been placed in a foster home or group home. Foster care and CPO contact were dichotomized as yes versus no, and adolescents could indicate yes to one of the items or both.
Poverty. Two items were used to assess the frequency of financial difficulty for the participant’s family (before 16 years for the parent respondents and presently for the adolescent respondents). The first item asked specifically about difficulty paying rent or the mortgage on the house and the second item asked about difficulty paying for basic necessities like food or clothing. Each item was dichotomized as sometimes or more often as a proxy for poverty versus rarely or never. Participants who indicated frequent financial difficulty for either one or both items were coded as yes for this proxy of poverty.
Parents were asked two questions about peer victimization: 1) Sometimes kids get hassled or picked on by other kids who say hurtful or mean things to them. Before the age of 16, how many times did this happen to you? and 2) Sometimes kids get physically pushed around, hit or beaten up by other kids or a group of kids. Before the age of 16, how many times did this happen to you? Both items were dichotomized, with the first item coded as yes if the participant indicated that this occurred more than 10 times and the second item coded yes if it occurred 3 to 5 times or more. Adolescents were asked about seven forms of peer victimization in the past 12 months, including: 1) bullied, picked on you, or said means things about you, or threatened you through texting or the Internet (e.g., posted something on Facebook or other social media, or sent texts or emails); 2) made fun of you, called you names or insulted you in person or behind your back, but excluding texting, email, social media, or online posting or communications; 3) spread rumors about you in person or behind your back, but excluding texting, email, social media, or online posting or communications; 4) pushed you, shoved you, tripped you, or spit on you; 5) said something bad about your race, culture, or religion in person or behind your back, but excluding texting, email, social media, or online posting or communications; 6) said something bad about your sexual orientation or gender identity in person or behind your back, but excluding texting, email social media, or online posting or communications; and 7) said something bad about your body shape, size, or appearance in person or behind your back, but excluding texting, email, social media, or online posting or communications. Response options were: never, 1 or 2 times a year, 3 to 6 times a year, 7 to 11 times a year, once a month, a couple times a month, once a week, a couple times a week, and every day. A single indicator for peer victimization was coded according to whether the participant reported experiencing any of these items once a month or more often.
Neighborhood safety was only assessed among adolescents. Respondents were asked to indicate how much they agree with the following statement: I feel safe in my community. If participants indicated that they strongly disagree or disagree with the statement, this item was coded as not safe.
Physical and mental health
Two items were used to assess respondents’ self-rated physical health (i.e., In general, how would you rate your physical health?) and mental health (i.e., In general, how would you rate your mental health?). Response categories were dichotomized as 1) excellent, very good, or good versus 2) fair or poor.
The sociodemographic characteristics of parents and adolescents that were included as covariates in the logistic regression models were sex (male or female), age in years, race/ethnicity (white only, white and another race or ethnicity, and other/multi-race or ethnicity), and household income ($49,999 or less, $50,000 to $99,999, $100,000 to $149,999, and $150,000 or more).
Confirmatory factor analysis (CFA) was conducted separately for parents and adolescents to examine how the expanded list of potential ACEs (i.e., spanking, parental gambling, foster care or CPO contact, poverty, peer victimization, and neighborhood safety) corresponded with the original ACEs items. Existing theoretical groupings in the ACEs literature identify two ACEs categories, including child maltreatment and peer victimization and household dysfunction or challenges [1, 10]. Based on this theoretical framework and the Ecological Systems theory, a two-factor model was specified for parents and adolescents in a following CFA. Additionally, we tested alternative one-factor and a three-factor models to determine the factor structure with the best fit. Models were standardized using the unit variance identification (UVI) constraint and estimated using mean- and variance-adjusted weighted least squares (WLSMV) estimation. Model fit was assessed with the model chi-square test (X2), Root Mean Square Error of Approximation (RMSEA) and its 90% confidence interval (CI), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Standardized Root Mean Square Residual (SRMR). CFA was conducted in Mplus 8.0 . Finally, logistic regression analyses were conducted to examine the associations of each of the individual ACEs (i.e., all original ACEs in addition to spanking, parental gambling, foster care or CPO contact, poverty, peer victimization, and neighborhood safety) and the confirmed factors with self-rated physical and mental health status. The models were first run unadjusted and then adjusting for sociodemographic characteristics. Inter-item tetrachoric correlations of ACEs among parents and adolescents were also computed.