Location, Location, Location: Assessing the Role of Context in Moderating the Relationship Between Childhood Adversity and Mental Health Burden

December 2023
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Adverse childhood experiences (ACEs) have profound mental health implications throughout the life course. While literature has focused on individual risk factors for ACEs and their burden on health, there are social and physical environmental contextual factors outside the individual that have been overlooked in studies of childhood adversity. This dissertation sought to understand how environmental context (social and physical environment) moderates the relationship between prior ACE exposure and mental health by using the 2015 Behavioral Risk Factor Surveillance System (BRFSS) and County Health Rankings. By using the BRFSS and the County Health Rankings, this dissertation assessed ACE burden and mental health as well as examined participants’ context at the county level. The goals of this dissertation are to: (1) explore how to define context using social and physical contextual variables, (2) evaluate if context can act as an effect modifier in the relationship between childhood adversity on mental health, and (3) assess if there are racial/ethnic differences on how context moderates ACE burden on mental health. The results of this proposal shed light on how certain aspects of context can buffer the burden of ACEs on mental health, and these results can be used as evidence for allocation of funds to help alleviate the ACE burden at the county level.