Adverse Childhood Experiences and Associated Health-Risk Behaviors among University Students in Turkey: A Cross-Sectional Analysis

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This study aimed to examine the association between ACEs and health-risk behaviors (HRBs) among university students in Turkey. A cross-sectional web-based survey was conducted between April and June 2024 with 1,115 university students aged 18–27 years. Data were collected using a structured self-report questionnaire assessing exposure to ACEs, including child maltreatment and household dysfunction, as well as a range of HRBs in young adulthood. Overall, 97.7% of participants reported experiencing at least one ACE, while 47.8% reported exposure to four or more ACEs. The most frequently reported ACEs were community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), witnessing violence against household members (39.2%), bullying (33.2%), and physical abuse (27.9%). A higher number of ACEs was significantly associated with several HRBs, including tobacco use, alcohol consumption, sedentary behavior, overweight and obesity, suicidal ideation, suicide attempts, interpersonal violence, and early sexual initiation (before age 16). These findings demonstrate a strong association between cumulative exposure to childhood adversity and multiple health-risk behaviors in young adulthood. The results highlight the need for trauma-informed public health strategies aimed at preventing ACEs and promoting resilience to reduce the long-term health consequences of childhood adversity. Adverse childhood experiences health risk students Turkey Introduction Adverse Childhood Experiences (ACEs) encompass significant and prolonged stressors encountered during early childhood. These experiences involve various forms of abuse, including physical, emotional, and sexual abuse, as well as neglectful caregiving. ACEs also refer to exposure to parental violence, living in environments where substance misuse is prevalent, and witnessing aggression within peer groups, communities, or broader social contexts. Increasing evidence suggests that sustained stress in childhood can have lasting effects on both mental and physical health. Such negative experiences can disrupt normal brain development and impair the function of the nervous and immune systems (World Health Organization [WHO], 2024a). ACEs are widespread, with approximately 64% of adults in the United States reporting having experienced at least one ACE before the age of 18. Furthermore, nearly 17.3%—equivalent to one in six adults—report encountering four or more categories of ACEs (Centers for Disease Control and Prevention [CDC], 2024). As part of a collaborative initiative led by the WHO Regional Office, surveys were conducted to assess the prevalence of ACEs among nationally representative groups of university students across eight Eastern European countries: Albania, Lithuania, Montenegro, Romania, North Macedonia, the Russian Federation, and Turkey. A comprehensive analysis of data from 10,696 individuals aged 18 to 25 revealed that more than 50% of participants had experienced at least one form of childhood adversity. Prevalence rates for specific ACEs included physical abuse (18.6%), emotional neglect (11.8%), emotional abuse (8%), and sexual abuse (7.5%). The most commonly reported ACE was witnessing maternal-targeted violence, which was cited by 14.6% of respondents (Sethi et al., 2013 ). ACEs can hinder the development of effective coping strategies, negatively influencing individuals’ behavioral health, physical and mental well-being, life outcomes, and potentially increasing the likelihood of early mortality. An expanding body of research highlights a strong correlation between ACE exposure and a higher risk of alcohol and substance use disorders, suicidal thoughts, various psychiatric disorders, cardiovascular diseases, other chronic health issues, and engagement in behaviors that compromise health throughout life (Merrick et al., 2019 ). Empirical findings from a study in Moldova showed that young individuals with a history of ACEs were significantly more likely to engage in unhealthy lifestyle practices compared to their peers without such experiences. Additionally, the frequency of these behaviors was found to increase in relation to the number of ACEs reported (Leșco et al., 2018 ). A similar study in Malaysia found that those exposed to ACEs were more vulnerable to health-risk behaviors (HRBs), with the risk escalating with the accumulation of adverse experiences (Majid et al., 2023 ). Numerous studies have explored the prevalence of various forms of violence faced by children and adolescents within national contexts (Chousko et al., 2023; Sofuoğlu et al., 2016 ). However, few studies have examined the relationship between exposure to ACEs—including sexual, physical, or emotional abuse, as well as family dysfunction—and the subsequent development of health-risk behaviors. The results of this survey are anticipated to contribute to the formulation of both regional and national strategies aimed at eradicating all forms of violence against children. These findings are expected to play a crucial role in shaping a national action framework and guiding the development of evidence-based policies for preventing child maltreatment and neglect. In this context, the survey results will provide valuable insights for policymakers and non-governmental organizations in designing and implementing targeted interventions to prevent violence at local and national levels. This research aimed to assess the prevalence of ACEs and their impact on health-risk behaviors (HRBs) by collecting data on adverse life events experienced during the first 18 years of life among university students in Turkey. The study sought to examine the relationship between ACE exposure and the emergence of risky behaviors and health-related issues in early adulthood. Methods and Materials Study design and population This study employed a web-based cross-sectional design and was conducted between April and June 2024 among university students in Turkey. Participants were recruited using a non-probability sampling strategy via online platforms, including social media networks widely used by university students. The survey link was disseminated through various student groups and digital communities to reach students from different universities and regions across Turkey, thereby enhancing the diversity of the sample. Eligibility criteria included being (1) currently enrolled as a university student in Turkey, (2) aged 18 years or older, and (3) willing to participate voluntarily in the study. Students who did not complete the questionnaire or who did not provide informed consent were excluded from the analysis. The minimum required sample size was calculated using the formula n = t²pq / d². The estimated prevalence of adverse childhood experiences (p) was set at 0.50 to ensure the maximum sample size, with q = 1 − p = 0.50 and a margin of error (d) of 0.03. At a 95% confidence level, the minimum required sample size was calculated as 1,067 participants. A total of 1,115 students completed the survey and were included in the final analysis. Data were collected using an anonymous online questionnaire created with a secure survey platform. The survey link was distributed through social media platforms and student communication networks. Before accessing the questionnaire, participants were presented with an online informed consent form explaining the aim of the study, voluntary participation, and confidentiality of responses. Only participants who provided electronic consent were allowed to proceed to the questionnaire. The survey was designed to be completed within approximately 10–15 minutes, and no personally identifiable information was collected to ensure participant anonymity. Data Collection Tools Socio‑Demographic Information Form The survey collected data on participants' socio-demographic characteristics, including variables such as age, gender, living conditions, parental education levels, marital status of parents, family structure, and perceived socio-economic status during childhood. Adverse Childhood Experiences The ACE International Questionnaire (ACE-IQ) was utilized to assess ACEs across various countries and to examine their relationship with health-risk behaviors in adulthood. Designed for individuals aged 18 years and older, the ACE-IQ includes questions concerning different types of family dysfunction, as well as experiences of physical, sexual, and emotional abuse or neglect by parents or caregivers, peer violence, community violence, and collective violence. Participants respond to each item with "yes" or "no," assigning a score of 1 for each "yes" response. The ACE score ranges from 0 to 13, with higher scores indicating greater exposure to ACEs (World Health Organization [WHO], 2024a). Health Risk Behaviors The survey also included questions assessing various health risk behaviors, such as tobacco use, alcohol consumption, inadequate fruit and vegetable intake, physical inactivity, sedentary leisure habits, overweight and obesity (BMI ≥ 25 kg/m²), substance use, suicidal thoughts, suicide attempts, violent behavior, and early initiation of sexual activity (before the age of 16) (World Health Organization [WHO], 2024b; WHO, 2024c). Detailed definitions, questions, and coding methods for these outcome variables are provided in Table 1 . Table 1 Variable description (health risk behaviours) Variables Survey question Coding Tobacco use Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? (0) No (1) Yes Alcohol consumption Have you consumed any alcohol within the past 12 months? (0) No (1) Yes Low fruit and vegetable consumption During the past 30 days, how many times per day did you usually eat fruits & vegetables (0) Less than 5 time per day (1) 5 or more times per day Physical inactivity During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? ADD UP ALL THE TIME YOU SPENT IN ANY KIND OF PHYSICAL ACTIVITY EACH DAY. (0) 1 or more days (1) 0 days Sedentary leisure behaviour How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities? (0) Less than 3 hour per day (1) 3 or more hours per day Height How tall are you without your shoes on? in Centimetres (cm) Weight How much do you weigh without your shoes on? in Kilograms (kg) Overweight and obesity It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). (0) BMI ≤ 24.9 (1) BMI ≥ 25.0 Drug use During the past 30 days, how many times have you used drug (marijuana, amphetamines, cocaine, and inhalants)? (0) 0 times (1) 1 or more times Suicide ideation During the past 12 months, did you ever seriously consider attempting suicide? (0) No (1) Yes Suicide attempts During the past 12 months, how many times did you actually attempt suicide? (0) 0 times (1) 1 or more times Violence In the past 12 months, how many times were you in a violent incident in which you were injured and required medical attention? (0) 0 times (1) 1 or more times Early sex (< 16 years) How old were you when you had sexual intercourse for the first time? (0) I have never had sexual intercourse/17 years old or older (1) 15 years old or younger Ethical Considerations This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University … (Approval Date: 06.03.2024 / Approval No: 03/08). Statistical Analyses Data were analyzed using IBM SPSS Statistics version 28, with a significance level set at p < 0.05. Prevalence rates for ACEs and health-risk behaviors were computed using relative frequencies. Differences in proportions and means between independent and dependent variables were assessed using the Pearson chi-square test, Mann-Whitney U test, and Kruskal-Wallis H test. The relationship between ACEs and health-risk behaviors was evaluated using odds ratios (OR). Logistic regression analysis was applied to explore the connection between ACEs and other factors while adjusting for demographic variables. The association coefficients from the logistic regression, along with 95% confidence intervals, were used to estimate demographic characteristics at the population level. Results Table 2 presents the socio-demographic characteristics of the participants and their associations with ACEs. A total of 1,115 valid responses were included in the analysis, with 809 (72.6%) from females and 306 (27.4%) from males. The participants' average age was 21.17 years (SD = 2.49), ranging from 18 to 27 years, with 65.0% of respondents aged between 18 and 21 years. Regarding parental education, 13.6% of fathers and 5.5% of mothers had completed at least high school education or higher. In terms of residential area, 74.9% of participants lived in urban locations, while 25.1% resided in rural areas. Most participants' parents (87.0%) were married, while 13.0% were either divorced or separated. A majority (70.9%) of the participants came from nuclear families. Socio-economic status was categorized as middle (64.9%), high (22.2%), and low (12.8%). Statistically significant associations between ACEs and gender, father's education, parental marital status, family structure, and childhood socio-economic status were observed (p 0.05) (Table 2 ). Table 2 Sociodemographic characteristics of students in the study population by ACE scores Characteristics ACE score n % Mean ± Std. Deviation p Age groups (Mean ± SD = 21.17 ± 2.49) 18–19 years old 20–21 years old ≥ 22 years old 215 510 390 19.3 45.7 35.0 3.61 ± 2.11 3.67 ± 2.15 3.82 ± 2.20 0.48 b Gender identity Male Female 306 809 27.4 72.6 4.01 ± 2.25 3.60 ± 2.12 < 0.05 a Residential status Rural Urban 280 835 25.1 74.9 3.81 ± 2.20 3.68 ± 2.15 0.32 a Father's education Low Medium High 649 314 152 58.2 28.2 13.6 3.84 ± 2.19 3.63 ± 2.15 3.33 ± 2.03 < 0.05 b Mothers' education Low Medium High 857 197 61 76.9 17.7 5.5 3.67 ± 2.11 3.97 ± 2.31 3.49 ± 2.32 0.11 b Parental marital status Married Divorced or separated 970 145 87.0 13.0 3.54 ± 2.05 4.84 ± 2.55 < 0.05 a Types of family Extended family Nuclear family Single parent family 257 791 67 23.0 70.9 6.0 3.62 ± 2.17 3.56 ± 2.04 5.85 ± 2.45 < 0.05 b Childhood socioeconomic status Lower Middle Higher 143 724 248 12.8 64.9 22.2 4.86 ± 2.36 3.70 ± 2.11 3.08 ± 2.11 < 0.05 b Total 1115 100 3.71 ± 2.16 a = Mann-Whitney U Test; b = Kruskal-Wallis H Test Table 3 outlines the frequency and prevalence of ACEs during the first 18 years of life, categorized by gender and overall. The most frequently reported ACEs were community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), violence against household members (39.2%), bullying (33.2%), and physical abuse (27.9%). Males reported higher rates of physical abuse (41.5% vs. 22.7%), emotional abuse (59.5% vs. 46.2%), community violence (87.6% vs. 78.6%), and collective violence (24.2% vs. 9.4%) compared to females. Conversely, females reported higher instances of contact sexual abuse (12.1% vs. 5.6%) and emotional neglect (79.1% vs. 60.5%) than males. Table 3 Prevalence (%) of ACE reported in the first 18 years of life by gender ACE categories Male Female Total p c n % n % n % Physical abuse 127 41.5 184 22.7 311 27.9 < 0.05 Emotional abuse 182 59.5 374 46.2 556 49.9 < 0.05 Contact sexual abuse 17 5.6 98 12.1 115 10.3 < 0.05 Alcohol and/or drug abuser in the household 18 5.9 39 4.8 57 5.1 0.47 Incarcerated household member 23 7.5 40 4.9 63 5.7 0.09 Someone chronically depressed, mentally ill, institutionalized or suicidal 27 8.8 82 10.1 109 9.8 0.51 Household member treated violently 123 40.2 314 38.8 437 39.2 0.67 One or no parents, parental separation or divorce 42 13.7 94 11.6 136 12.2 0.33 Emotional neglect 185 60.5 640 79.1 825 74.0 < 0.05 Physical neglect 28 9.2 77 9.5 105 9.4 0.85 Bullying 113 36.9 257 31.8 370 33.2 0.10 Community violence 268 87.6 636 78.6 904 81.1 < 0.05 Collective violence 74 24.2 76 9.4 150 13.5 < 0.05 Number of ACEs 0 ACEs 15 4.9 22 2.7 37 3.3 1 ACE 26 8.5 88 10.9 114 10.2 2 ACEs 51 16.7 193 23.9 244 21.9 3 ACEs 37 12.1 150 18.5 187 16.8 ≥ 4 ACEs 177 57.8 356 44.0 533 47.8 c = Chi-Square Test Table 4 shows the distribution of ACEs scores among the 1,115 participants, separated by gender. Among the respondents, 37 (3.3%) reported no ACEs, while 97.7% indicated having experienced at least one ACE. The prevalence of ACEs was significantly higher in males than females (p < 0.05). Table 4 Prevalence and adjusted odds ratios of risky health behaviours of respondents according to the numbers of reported ACE category Health Risk Behaviours Number of ACEs p ≤ 3 ACEs (N = 582) ≥ 4 ACEs (n = 533) Tobacco use % 18.7 38.8 AOR 1.00 2.47 < 0.05 (95% CI) 1.84–3.31* Alcohol consumption % 15.3 33.0 AOR 1.00 2.41 < 0.05 (95% CI) 1.77–3.29 Low fruit and vegetable consumption % 86.1 89.3 AOR 1.00 1.23 0.26 (95% CI) 0.85–1.80 Physical inactivity % 22.2 19.7 AOR 1.00 0.87 0.38 (95% CI) 0.64–1.18 Sedentary leisure behaviour % 77.5 81.6 AOR 1.00 1.45 < 0.05 (95% CI) 1.06–1.97 Overweight and obesity % 19.6 27.6 AOR 1.00 1.47 < 0.05 (95% CI) 1.10–1.97 Drug use % 0.5 1.3 AOR 1.00 1.88 0.39 (95% CI) 0.43–8.11 Suicidal ideation % 3.4 16.7 AOR 1.00 4.74 < 0.05 (95% CI) 2.83–7.93 Suicide attempts % 0.7 4.5 AOR 1.00 5.26 < 0.05 (95% CI) 1.76–15.69 Violence % 16.3 25.5 AOR 1.00 1.60 < 0.05 (95% CI) 1.17–2.18 Early sex (< 16 years) % 0.5 3.4 AOR 1.00 4.51 < 0.05 (95% CI) 1.25–16.24 AOR: Adjusted Odds Ratio; CI: confidence interval. Odds ratios adjusted for age, gender, residential status, father's education, mothers' education, parental marital status, types of family and childhood socioeconomic status. Table 5 presents the relationship between the number of ACEs and the likelihood of engaging in health-risk behaviors. The data indicate a clear association between the number of ACEs and the probability of engaging in such behaviors. Respondents who reported four or more ACEs exhibited the highest likelihood of engaging in risky health behaviors. Specifically, individuals with four or more ACEs had significantly higher odds ratios (OR) for various health-risk behaviors compared to those with three or fewer ACEs. These behaviors include tobacco use (OR = 2.47), alcohol consumption (OR = 2.41), sedentary leisure activities (OR = 1.45), overweight and obesity (OR = 1.47), suicidal ideation (OR = 4.74), suicide attempts (OR = 5.26), violent behavior (OR = 1.60), and early sexual initiation (before age 16) (OR = 4.51). Discussion Our study found a notably high prevalence of ACEs among university students in Turkey, with 97.7% of participants reporting exposure to at least one ACE. Furthermore, approximately 47.8% of the participants reported experiencing four or more ACEs. These findings are consistent with previous studies involving university students in other countries (Agbaje et al., 2021 ; Laurinaitytė et al., 2022 ; Muwanguzi et al., 2023 ). For instance, a study with Ugandan university students revealed that nearly all participants (99.8%) had experienced at least one ACE, with 80.0% reporting four or more ACEs (Muwanguzi et al., 2023 ). In Lithuania, 8.7% of university students reported no ACEs, while almost half (48.9%) reported four or more (Laurinaitytė et al., 2022 ). Similarly, in Southeast Nigeria, 86.7% of university students reported experiencing ACEs, with 41.3% reporting four or more (Agbaje et al., 2021 ). Other studies, however, have shown more varied rates of exposure to at least one ACE, ranging from 58.3% to 76.0% (King et al., 2024 ; Risso et al., 2024 ; Tran et al., 2015 ; Zhang et al., 2020 ). For instance, in Zambia, 58.3% of university students reported at least one ACE, with 27.6% reporting one ACE, 16.3% reporting two ACEs, and 14.4% experiencing three or more (Zhang et al., 2020 ). In the United States, 72.3% of university students reported at least one ACE, with 21.7% reporting five or more distinct ACEs (King et al., 2024 ). Similarly, 74.4% of Brazilian students reported experiencing at least one ACE, with 13.1% reporting four or more (Risso et al., 2024 ). A study in Vietnam found that 76.0% of university students had experienced at least one ACE, with 21% reporting four or more (Tran et al., 2015 ). These variations in prevalence rates are likely influenced by differences in socio-economic conditions, cultural contexts, and research methodologies across different studies. The context in Turkey, for instance, may differ substantially from those of other countries where much of the ACE research has been conducted. In our study, the most frequently reported ACEs among university students in Turkey included community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), violence towards family members (39.2%), bullying (33.2%), and physical abuse (27.9%). This pattern is somewhat different from findings in other regions. For example, a study in Moldova found that the most commonly reported ACEs included emotional abuse (15.1%), corporal punishment (20.2%), and emotional neglect (13%), with household dysfunctions such as parental separation or divorce (19.5%) and witnessing maternal abuse (13.1%) also prevalent (Leșco et al., 2018 ). In Romania, university students reported high rates of emotional abuse (23.6%), physical abuse (26.9%), physical neglect (16.5%), sexual abuse (12.7%), and emotional neglect (26.3%) (Baban et al., 2013 ). A study from Uganda revealed that physical abuse was the most common ACE (99.8%), with 29.1% reporting sexual abuse, 68.0% emotional neglect, and 57.3% emotional abuse (Muwanguzi et al., 2023 ). These differences in prevalence may be due to variations in sampling methods, definitions, and measurement criteria, as well as cultural differences in reporting. In cultures where discussing violence is more open, higher rates of violence-related behaviors might be reported as a public health issue. Our results also highlight a significant association between ACEs and various health outcomes and risk behaviors, including tobacco use, alcohol consumption, sedentary behavior, overweight and obesity, suicidal ideation, suicide attempts, involvement in violence, and early sexual initiation. The likelihood of engaging in health-risk behaviors increases with the number of ACEs reported. This finding aligns with previous studies (Islam et al., 2023 ; Majid et al., 2023 ; Maurya & Maurya, 2023 ; Xu et al., 2022 ; Zhang et al., 2020 ). For instance, a study conducted in Malaysia found that individuals exposed to ACEs were more likely to engage in health-risk behaviors, with a higher number of ACEs associated with an increased prevalence of these behaviors. The most commonly reported health-risk behaviors in Malaysia included physical inactivity (54.5%), obesity (28.8%), neglect of personal safety (20.6%), persistent feelings of sadness (20.5%), smoking (12.4%), and alcohol consumption (12.2%) (Majid et al., 2023 ). Similarly, a study in India found that individuals with three or more ACEs were significantly more likely to engage in risky health behaviors compared to those without ACEs (Maurya & Maurya, 2023 ). In the United States, research has shown that ACEs are strongly linked to both mental and physical health issues, including harmful behaviors like excessive alcohol use, smoking, and chronic health conditions (Islam et al., 2023 ). A study in China indicated that ACEs were associated with poorer mental health outcomes such as loneliness, anxiety, and decreased life satisfaction, with exposure to four or more ACEs correlating negatively with smoking and heavy alcohol consumption (Xu et al., 2022 ). Research in Zambia also pointed to an association between ACEs and increased likelihood of smoking, heavy alcohol use, risky sexual behaviors, suicide attempts, and illicit drug use (Zhang et al., 2020 ). This study has several limitations. First, the target population was limited to university students, which may not fully represent the broader young adult demographic, including those who are employed, unemployed, or not engaged in university life. Therefore, the findings may primarily reflect the experiences of university students rather than the wider young adult population. Second, the study relies on self-reported data, which may be influenced by socially desirable responses. Despite assurances of confidentiality, participants may underreport sensitive experiences such as sexual abuse. Third, the retrospective nature of self-reported childhood experiences introduces the potential for recall bias, as participants may be more likely to recall recent or traumatic incidents. Longitudinal data collection from childhood could mitigate this issue, though such an approach would present both financial and ethical challenges. Finally, as a cross-sectional study, this research cannot establish direct causal relationships between ACEs, health-risk behaviors, and later health outcomes. While the findings suggest associations between these variables, they do not confirm causality. Conclusion ACEs present a significant public health and societal challenge in Turkey, with profound and long-lasting effects on both the mental and physical health of individuals, as well as their social development. This study highlights the high prevalence of ACEs among university students in Turkey, demonstrating that those with a history of ACEs are more likely to engage in health-risk behaviors, further exacerbating the long-term consequences of these early adversities. To mitigate the impact of ACEs, prevention programs aimed at reducing their incidence from an early age are crucial. Such programs provide significant public health and societal benefits. Understanding the factors that either increase the risk of violence or offer protective mechanisms against it is essential for designing effective prevention strategies. Creating safe, stable, and supportive environments and relationships for children is fundamental in preventing ACEs and promoting the optimal development of every child (CDC, 2024). Child advocates play a pivotal role in advancing effective strategies for preventing and intervening in ACEs. A comprehensive understanding of ACEs, including their prevalence and their relationship with health-risk behaviors (HRBs), is essential for tackling long-term health challenges. Continued research is necessary to enhance screening methods, develop effective prevention programs, and refine therapeutic interventions. Additionally, policymakers must prioritize the protection of children's rights and take proactive steps to prevent exploitation through comprehensive frameworks and stringent legislation. Ongoing zero-tolerance campaigns against violence, the promotion of non-violent communication, the prohibition of violent disciplinary practices, and the advancement of gender equality and non-discrimination are critical in raising awareness and driving sustained efforts to shift societal norms, values, and attitudes. Declarations Competing interests: The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University ... (Date: 06.03.2024/No: 03/08). Clinical trial number Not applicable. Informed consent: Informed consent was obtained from all individual participants included in the study. Funding: The authors did not receive support from any organization for the submitted work. Author Contribution Author contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Hasan Hüseyin ÇAM] and [Fadime Ustuner TOP]. The first draft of the manuscript was written by [Hasan Hüseyin ÇAM] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank all the students who participated in the study. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Agbaje, O. S., Nnaji, C. P., Nwagu, E. N., Iweama, C. N., Umoke, P. C. I., Ozoemena, L. E., & Abba, C. C. (2021). 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European report on preventing child maltreatment. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/326375 Sofuoğlu, Z., Sarıyer, G., & Ataman, M. G. (2016). Child Maltreatment in Turkey: Comparison of Parent and Child Reports. Central European journal of public health , 24 (3), 217–222. https://doi.org/10.21101/cejph.a4155 Tran, Q. A., Dunne, M. P., Vo, T. V., & Luu, N. H. (2015). Adverse Childhood Experiences and the Health of University Students in Eight Provinces of Vietnam. Asia-Pacific journal of public health , 27 (8 Suppl), 26S–32S. https://doi.org/10.1177/1010539515589812 World Health Organization. (2024a). Adverse Childhood Experiences International Questionnaire. https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq) World Health Organization. (2024b). WHO STEPwise Approach to Chronic Disease Risk-Factor Surveillance. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps/manuals World Health Organization. (2024c). Global School-based Student Health Survey. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-school-based-student-health-survey Xu, Z., Zhang, D., Ding, H., Zheng, X., Lee, R. C., Yang, Z., Mo, P. K., Lee, E. K., & Wong, S. Y. (2022). Association of positive and adverse childhood experiences with risky behaviours and mental health indicators among Chinese university students in Hong Kong: an exploratory study. European journal of psychotraumatology , 13 (1), 2065429. https://doi.org/10.1080/20008198.2022.2065429 Zhang, J., Tang, B. W., Liu, M. W., Yuan, S., Yu, H. J., Zhang, R., Huang, X. C., Nzala, S. H., Chikoya, M., Wang, P. G., & He, Q. Q. (2020). Association of Adverse Childhood Experiences with Health Risk Behaviors Among College Students in Zambia. International journal of behavioral medicine , 27 (4), 400–405. https://doi.org/10.1007/s12529-020-09863-y Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9117010","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618169831,"identity":"140cd824-3b47-4b61-a19d-a8b0334f47ce","order_by":0,"name":"Hasan Hüseyin Çam","email":"data:image/png;base64,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","orcid":"","institution":"Kahramanmaraş İstiklal University","correspondingAuthor":true,"prefix":"","firstName":"Hasan","middleName":"Hüseyin","lastName":"Çam","suffix":""},{"id":618169834,"identity":"c12ea442-9158-4e6b-87fe-c90dc0ce8677","order_by":1,"name":"Fadime Ustuner Top","email":"","orcid":"","institution":"Giresun University","correspondingAuthor":false,"prefix":"","firstName":"Fadime","middleName":"Ustuner","lastName":"Top","suffix":""}],"badges":[],"createdAt":"2026-03-13 17:09:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9117010/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9117010/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106726498,"identity":"022fb92a-de1e-42d5-91b3-7fe115895890","added_by":"auto","created_at":"2026-04-12 18:36:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1696581,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9117010/v1/ce11e169-7dd6-40e2-b244-72f738d22f9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adverse Childhood Experiences and Associated Health-Risk Behaviors among University Students in Turkey: A Cross-Sectional Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdverse Childhood Experiences (ACEs) encompass significant and prolonged stressors encountered during early childhood. These experiences involve various forms of abuse, including physical, emotional, and sexual abuse, as well as neglectful caregiving. ACEs also refer to exposure to parental violence, living in environments where substance misuse is prevalent, and witnessing aggression within peer groups, communities, or broader social contexts. Increasing evidence suggests that sustained stress in childhood can have lasting effects on both mental and physical health. Such negative experiences can disrupt normal brain development and impair the function of the nervous and immune systems (World Health Organization [WHO], 2024a).\u003c/p\u003e \u003cp\u003eACEs are widespread, with approximately 64% of adults in the United States reporting having experienced at least one ACE before the age of 18. Furthermore, nearly 17.3%\u0026mdash;equivalent to one in six adults\u0026mdash;report encountering four or more categories of ACEs (Centers for Disease Control and Prevention [CDC], 2024). As part of a collaborative initiative led by the WHO Regional Office, surveys were conducted to assess the prevalence of ACEs among nationally representative groups of university students across eight Eastern European countries: Albania, Lithuania, Montenegro, Romania, North Macedonia, the Russian Federation, and Turkey. A comprehensive analysis of data from 10,696 individuals aged 18 to 25 revealed that more than 50% of participants had experienced at least one form of childhood adversity. Prevalence rates for specific ACEs included physical abuse (18.6%), emotional neglect (11.8%), emotional abuse (8%), and sexual abuse (7.5%). The most commonly reported ACE was witnessing maternal-targeted violence, which was cited by 14.6% of respondents (Sethi et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eACEs can hinder the development of effective coping strategies, negatively influencing individuals\u0026rsquo; behavioral health, physical and mental well-being, life outcomes, and potentially increasing the likelihood of early mortality. An expanding body of research highlights a strong correlation between ACE exposure and a higher risk of alcohol and substance use disorders, suicidal thoughts, various psychiatric disorders, cardiovascular diseases, other chronic health issues, and engagement in behaviors that compromise health throughout life (Merrick et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Empirical findings from a study in Moldova showed that young individuals with a history of ACEs were significantly more likely to engage in unhealthy lifestyle practices compared to their peers without such experiences. Additionally, the frequency of these behaviors was found to increase in relation to the number of ACEs reported (Leșco et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A similar study in Malaysia found that those exposed to ACEs were more vulnerable to health-risk behaviors (HRBs), with the risk escalating with the accumulation of adverse experiences (Majid et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNumerous studies have explored the prevalence of various forms of violence faced by children and adolescents within national contexts (Chousko et al., 2023; Sofuoğlu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). However, few studies have examined the relationship between exposure to ACEs\u0026mdash;including sexual, physical, or emotional abuse, as well as family dysfunction\u0026mdash;and the subsequent development of health-risk behaviors.\u003c/p\u003e \u003cp\u003eThe results of this survey are anticipated to contribute to the formulation of both regional and national strategies aimed at eradicating all forms of violence against children. These findings are expected to play a crucial role in shaping a national action framework and guiding the development of evidence-based policies for preventing child maltreatment and neglect. In this context, the survey results will provide valuable insights for policymakers and non-governmental organizations in designing and implementing targeted interventions to prevent violence at local and national levels.\u003c/p\u003e \u003cp\u003eThis research aimed to assess the prevalence of ACEs and their impact on health-risk behaviors (HRBs) by collecting data on adverse life events experienced during the first 18 years of life among university students in Turkey. The study sought to examine the relationship between ACE exposure and the emergence of risky behaviors and health-related issues in early adulthood.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eThis study employed a web-based cross-sectional design and was conducted between April and June 2024 among university students in Turkey. Participants were recruited using a non-probability sampling strategy via online platforms, including social media networks widely used by university students. The survey link was disseminated through various student groups and digital communities to reach students from different universities and regions across Turkey, thereby enhancing the diversity of the sample. Eligibility criteria included being (1) currently enrolled as a university student in Turkey, (2) aged 18 years or older, and (3) willing to participate voluntarily in the study. Students who did not complete the questionnaire or who did not provide informed consent were excluded from the analysis. The minimum required sample size was calculated using the formula n\u0026thinsp;=\u0026thinsp;t\u0026sup2;pq / d\u0026sup2;. The estimated prevalence of adverse childhood experiences (p) was set at 0.50 to ensure the maximum sample size, with q\u0026thinsp;=\u0026thinsp;1\u0026thinsp;\u0026minus;\u0026thinsp;p\u0026thinsp;=\u0026thinsp;0.50 and a margin of error (d) of 0.03. At a 95% confidence level, the minimum required sample size was calculated as 1,067 participants. A total of 1,115 students completed the survey and were included in the final analysis. Data were collected using an anonymous online questionnaire created with a secure survey platform. The survey link was distributed through social media platforms and student communication networks. Before accessing the questionnaire, participants were presented with an online informed consent form explaining the aim of the study, voluntary participation, and confidentiality of responses. Only participants who provided electronic consent were allowed to proceed to the questionnaire. The survey was designed to be completed within approximately 10\u0026ndash;15 minutes, and no personally identifiable information was collected to ensure participant anonymity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSocio‑Demographic Information Form\u003c/h2\u003e \u003cp\u003eThe survey collected data on participants' socio-demographic characteristics, including variables such as age, gender, living conditions, parental education levels, marital status of parents, family structure, and perceived socio-economic status during childhood.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdverse Childhood Experiences\u003c/h3\u003e\n\u003cp\u003eThe ACE International Questionnaire (ACE-IQ) was utilized to assess ACEs across various countries and to examine their relationship with health-risk behaviors in adulthood. Designed for individuals aged 18 years and older, the ACE-IQ includes questions concerning different types of family dysfunction, as well as experiences of physical, sexual, and emotional abuse or neglect by parents or caregivers, peer violence, community violence, and collective violence. Participants respond to each item with \"yes\" or \"no,\" assigning a score of 1 for each \"yes\" response. The ACE score ranges from 0 to 13, with higher scores indicating greater exposure to ACEs (World Health Organization [WHO], 2024a).\u003c/p\u003e\n\u003ch3\u003eHealth Risk Behaviors\u003c/h3\u003e\n\u003cp\u003eThe survey also included questions assessing various health risk behaviors, such as tobacco use, alcohol consumption, inadequate fruit and vegetable intake, physical inactivity, sedentary leisure habits, overweight and obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;), substance use, suicidal thoughts, suicide attempts, violent behavior, and early initiation of sexual activity (before the age of 16) (World Health Organization [WHO], 2024b; WHO, 2024c). Detailed definitions, questions, and coding methods for these outcome variables are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariable description (health risk behaviours)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvey question\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo you currently smoke any tobacco products, such as cigarettes, cigars or pipes?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) No\u003c/p\u003e \u003cp\u003e(1) Yes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave you consumed any alcohol within the past 12 months?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) No\u003c/p\u003e \u003cp\u003e(1) Yes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow fruit and vegetable consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 30 days, how many times per day did you usually eat fruits \u0026amp; vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) Less than 5 time per day\u003c/p\u003e \u003cp\u003e(1) 5 or more times per day\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical inactivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? ADD UP ALL THE TIME YOU SPENT IN ANY KIND OF PHYSICAL ACTIVITY EACH DAY.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) 1 or more days\u003c/p\u003e \u003cp\u003e(1) 0 days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSedentary leisure behaviour\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) Less than 3 hour per day\u003c/p\u003e \u003cp\u003e(1) 3 or more hours per day\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow tall are you without your shoes on?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ein Centimetres (cm)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much do you weigh without your shoes on?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ein Kilograms (kg)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverweight and obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is defined as the weight in kilograms divided by the square of the height in metres (kg/m2).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) BMI\u0026thinsp;\u0026le;\u0026thinsp;24.9\u003c/p\u003e \u003cp\u003e(1) BMI\u0026thinsp;\u0026ge;\u0026thinsp;25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 30 days, how many times have you used drug (marijuana, amphetamines, cocaine, and inhalants)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) 0 times\u003c/p\u003e \u003cp\u003e(1) 1 or more times\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuicide ideation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 12 months, did you ever seriously consider attempting suicide?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) No\u003c/p\u003e \u003cp\u003e(1) Yes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuicide attempts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 12 months, how many times did you actually attempt suicide?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) 0 times\u003c/p\u003e \u003cp\u003e(1) 1 or more times\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eViolence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn the past 12 months, how many times were you in a violent incident in which you were injured and required medical attention?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) 0 times\u003c/p\u003e \u003cp\u003e(1) 1 or more times\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly sex\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(\u0026lt;\u0026thinsp;16 years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow old were you when you had sexual intercourse for the first time?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0) I have never had sexual intercourse/17 years old or older\u003c/p\u003e \u003cp\u003e(1) 15 years old or younger\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University \u0026hellip; (Approval Date: 06.03.2024 / Approval No: 03/08).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eData were analyzed using IBM SPSS Statistics version 28, with a significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Prevalence rates for ACEs and health-risk behaviors were computed using relative frequencies. Differences in proportions and means between independent and dependent variables were assessed using the Pearson chi-square test, Mann-Whitney U test, and Kruskal-Wallis H test. The relationship between ACEs and health-risk behaviors was evaluated using odds ratios (OR). Logistic regression analysis was applied to explore the connection between ACEs and other factors while adjusting for demographic variables. The association coefficients from the logistic regression, along with 95% confidence intervals, were used to estimate demographic characteristics at the population level.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the socio-demographic characteristics of the participants and their associations with ACEs. A total of 1,115 valid responses were included in the analysis, with 809 (72.6%) from females and 306 (27.4%) from males. The participants' average age was 21.17 years (SD\u0026thinsp;=\u0026thinsp;2.49), ranging from 18 to 27 years, with 65.0% of respondents aged between 18 and 21 years. Regarding parental education, 13.6% of fathers and 5.5% of mothers had completed at least high school education or higher. In terms of residential area, 74.9% of participants lived in urban locations, while 25.1% resided in rural areas. Most participants' parents (87.0%) were married, while 13.0% were either divorced or separated. A majority (70.9%) of the participants came from nuclear families. Socio-economic status was categorized as middle (64.9%), high (22.2%), and low (12.8%). Statistically significant associations between ACEs and gender, father's education, parental marital status, family structure, and childhood socio-economic status were observed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no significant correlations were found between ACEs and age, residential status, or mother's education (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of students in the study population by ACE scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eACE score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std. Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;21.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;19 years old\u003c/p\u003e \u003cp\u003e20\u0026ndash;21 years old\u003c/p\u003e \u003cp\u003e\u0026ge; 22 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003cp\u003e510\u003c/p\u003e \u003cp\u003e390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003cp\u003e45.7\u003c/p\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender identity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e306\u003c/p\u003e \u003cp\u003e809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003cp\u003e72.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidential status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e280\u003c/p\u003e \u003cp\u003e835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003cp\u003e74.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e \u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.32\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather's education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eMedium\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e649\u003c/p\u003e \u003cp\u003e314\u003c/p\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003cp\u003e28.2\u003c/p\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMothers' education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eMedium\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e857\u003c/p\u003e \u003cp\u003e197\u003c/p\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003cp\u003e17.7\u003c/p\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003cp\u003e3.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental marital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorced or separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e970\u003c/p\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.0\u003c/p\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e \u003cp\u003e4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTypes of family\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended family\u003c/p\u003e \u003cp\u003eNuclear family\u003c/p\u003e \u003cp\u003eSingle parent family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e257\u003c/p\u003e \u003cp\u003e791\u003c/p\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003cp\u003e70.9\u003c/p\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003cp\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildhood socioeconomic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003cp\u003e724\u003c/p\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003cp\u003e64.9\u003c/p\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003cp\u003e3.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1115\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003ea\u0026thinsp;=\u0026thinsp;Mann-Whitney U Test; b\u0026thinsp;=\u0026thinsp;Kruskal-Wallis H Test\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e outlines the frequency and prevalence of ACEs during the first 18 years of life, categorized by gender and overall. The most frequently reported ACEs were community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), violence against household members (39.2%), bullying (33.2%), and physical abuse (27.9%). Males reported higher rates of physical abuse (41.5% vs. 22.7%), emotional abuse (59.5% vs. 46.2%), community violence (87.6% vs. 78.6%), and collective violence (24.2% vs. 9.4%) compared to females. Conversely, females reported higher instances of contact sexual abuse (12.1% vs. 5.6%) and emotional neglect (79.1% vs. 60.5%) than males.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence (%) of ACE reported in the first 18 years of life by gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eACE categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical abuse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional abuse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e49.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContact sexual abuse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol and/or drug abuser in the household\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncarcerated household member\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSomeone chronically depressed, mentally ill, institutionalized or suicidal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold member treated violently\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOne or no parents, parental\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eseparation or divorce\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional neglect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical neglect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBullying\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e78.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e81.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCollective violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ACEs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0 ACEs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1 ACE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 ACEs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3 ACEs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;4 ACEs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003ec\u0026thinsp;=\u0026thinsp;Chi-Square Test\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the distribution of ACEs scores among the 1,115 participants, separated by gender. Among the respondents, 37 (3.3%) reported no ACEs, while 97.7% indicated having experienced at least one ACE. The prevalence of ACEs was significantly higher in males than females (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and adjusted odds ratios of risky health behaviours of respondents according to the numbers of reported ACE category\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth Risk Behaviours\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNumber of ACEs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 ACEs\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;582)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4 ACEs\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;533)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.84\u0026ndash;3.31*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.77\u0026ndash;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow fruit and vegetable consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.85\u0026ndash;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical inactivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u0026ndash;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSedentary leisure behaviour\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.06\u0026ndash;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverweight and obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.10\u0026ndash;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u0026ndash;8.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuicidal ideation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.83\u0026ndash;7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuicide attempts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.76\u0026ndash;15.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eViolence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.17\u0026ndash;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly sex (\u0026lt;\u0026thinsp;16 years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.25\u0026ndash;16.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eAOR: Adjusted Odds Ratio; CI: confidence interval. Odds ratios adjusted for age, gender, residential status, father's education, mothers' education, parental marital status, types of family and childhood socioeconomic status.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;5 presents the relationship between the number of ACEs and the likelihood of engaging in health-risk behaviors. The data indicate a clear association between the number of ACEs and the probability of engaging in such behaviors. Respondents who reported four or more ACEs exhibited the highest likelihood of engaging in risky health behaviors. Specifically, individuals with four or more ACEs had significantly higher odds ratios (OR) for various health-risk behaviors compared to those with three or fewer ACEs. These behaviors include tobacco use (OR\u0026thinsp;=\u0026thinsp;2.47), alcohol consumption (OR\u0026thinsp;=\u0026thinsp;2.41), sedentary leisure activities (OR\u0026thinsp;=\u0026thinsp;1.45), overweight and obesity (OR\u0026thinsp;=\u0026thinsp;1.47), suicidal ideation (OR\u0026thinsp;=\u0026thinsp;4.74), suicide attempts (OR\u0026thinsp;=\u0026thinsp;5.26), violent behavior (OR\u0026thinsp;=\u0026thinsp;1.60), and early sexual initiation (before age 16) (OR\u0026thinsp;=\u0026thinsp;4.51).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study found a notably high prevalence of ACEs among university students in Turkey, with 97.7% of participants reporting exposure to at least one ACE. Furthermore, approximately 47.8% of the participants reported experiencing four or more ACEs. These findings are consistent with previous studies involving university students in other countries (Agbaje et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Laurinaitytė et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Muwanguzi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). For instance, a study with Ugandan university students revealed that nearly all participants (99.8%) had experienced at least one ACE, with 80.0% reporting four or more ACEs (Muwanguzi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In Lithuania, 8.7% of university students reported no ACEs, while almost half (48.9%) reported four or more (Laurinaitytė et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Similarly, in Southeast Nigeria, 86.7% of university students reported experiencing ACEs, with 41.3% reporting four or more (Agbaje et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Other studies, however, have shown more varied rates of exposure to at least one ACE, ranging from 58.3% to 76.0% (King et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Risso et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tran et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). For instance, in Zambia, 58.3% of university students reported at least one ACE, with 27.6% reporting one ACE, 16.3% reporting two ACEs, and 14.4% experiencing three or more (Zhang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In the United States, 72.3% of university students reported at least one ACE, with 21.7% reporting five or more distinct ACEs (King et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Similarly, 74.4% of Brazilian students reported experiencing at least one ACE, with 13.1% reporting four or more (Risso et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A study in Vietnam found that 76.0% of university students had experienced at least one ACE, with 21% reporting four or more (Tran et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These variations in prevalence rates are likely influenced by differences in socio-economic conditions, cultural contexts, and research methodologies across different studies. The context in Turkey, for instance, may differ substantially from those of other countries where much of the ACE research has been conducted.\u003c/p\u003e \u003cp\u003eIn our study, the most frequently reported ACEs among university students in Turkey included community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), violence towards family members (39.2%), bullying (33.2%), and physical abuse (27.9%). This pattern is somewhat different from findings in other regions. For example, a study in Moldova found that the most commonly reported ACEs included emotional abuse (15.1%), corporal punishment (20.2%), and emotional neglect (13%), with household dysfunctions such as parental separation or divorce (19.5%) and witnessing maternal abuse (13.1%) also prevalent (Leșco et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In Romania, university students reported high rates of emotional abuse (23.6%), physical abuse (26.9%), physical neglect (16.5%), sexual abuse (12.7%), and emotional neglect (26.3%) (Baban et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). A study from Uganda revealed that physical abuse was the most common ACE (99.8%), with 29.1% reporting sexual abuse, 68.0% emotional neglect, and 57.3% emotional abuse (Muwanguzi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These differences in prevalence may be due to variations in sampling methods, definitions, and measurement criteria, as well as cultural differences in reporting. In cultures where discussing violence is more open, higher rates of violence-related behaviors might be reported as a public health issue.\u003c/p\u003e \u003cp\u003eOur results also highlight a significant association between ACEs and various health outcomes and risk behaviors, including tobacco use, alcohol consumption, sedentary behavior, overweight and obesity, suicidal ideation, suicide attempts, involvement in violence, and early sexual initiation. The likelihood of engaging in health-risk behaviors increases with the number of ACEs reported. This finding aligns with previous studies (Islam et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Majid et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Maurya \u0026amp; Maurya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Xu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). For instance, a study conducted in Malaysia found that individuals exposed to ACEs were more likely to engage in health-risk behaviors, with a higher number of ACEs associated with an increased prevalence of these behaviors. The most commonly reported health-risk behaviors in Malaysia included physical inactivity (54.5%), obesity (28.8%), neglect of personal safety (20.6%), persistent feelings of sadness (20.5%), smoking (12.4%), and alcohol consumption (12.2%) (Majid et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Similarly, a study in India found that individuals with three or more ACEs were significantly more likely to engage in risky health behaviors compared to those without ACEs (Maurya \u0026amp; Maurya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In the United States, research has shown that ACEs are strongly linked to both mental and physical health issues, including harmful behaviors like excessive alcohol use, smoking, and chronic health conditions (Islam et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). A study in China indicated that ACEs were associated with poorer mental health outcomes such as loneliness, anxiety, and decreased life satisfaction, with exposure to four or more ACEs correlating negatively with smoking and heavy alcohol consumption (Xu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Research in Zambia also pointed to an association between ACEs and increased likelihood of smoking, heavy alcohol use, risky sexual behaviors, suicide attempts, and illicit drug use (Zhang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the target population was limited to university students, which may not fully represent the broader young adult demographic, including those who are employed, unemployed, or not engaged in university life. Therefore, the findings may primarily reflect the experiences of university students rather than the wider young adult population. Second, the study relies on self-reported data, which may be influenced by socially desirable responses. Despite assurances of confidentiality, participants may underreport sensitive experiences such as sexual abuse. Third, the retrospective nature of self-reported childhood experiences introduces the potential for recall bias, as participants may be more likely to recall recent or traumatic incidents. Longitudinal data collection from childhood could mitigate this issue, though such an approach would present both financial and ethical challenges. Finally, as a cross-sectional study, this research cannot establish direct causal relationships between ACEs, health-risk behaviors, and later health outcomes. While the findings suggest associations between these variables, they do not confirm causality.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eACEs present a significant public health and societal challenge in Turkey, with profound and long-lasting effects on both the mental and physical health of individuals, as well as their social development. This study highlights the high prevalence of ACEs among university students in Turkey, demonstrating that those with a history of ACEs are more likely to engage in health-risk behaviors, further exacerbating the long-term consequences of these early adversities.\u003c/p\u003e \u003cp\u003eTo mitigate the impact of ACEs, prevention programs aimed at reducing their incidence from an early age are crucial. Such programs provide significant public health and societal benefits. Understanding the factors that either increase the risk of violence or offer protective mechanisms against it is essential for designing effective prevention strategies. Creating safe, stable, and supportive environments and relationships for children is fundamental in preventing ACEs and promoting the optimal development of every child (CDC, 2024).\u003c/p\u003e \u003cp\u003eChild advocates play a pivotal role in advancing effective strategies for preventing and intervening in ACEs. A comprehensive understanding of ACEs, including their prevalence and their relationship with health-risk behaviors (HRBs), is essential for tackling long-term health challenges. Continued research is necessary to enhance screening methods, develop effective prevention programs, and refine therapeutic interventions. Additionally, policymakers must prioritize the protection of children's rights and take proactive steps to prevent exploitation through comprehensive frameworks and stringent legislation. Ongoing zero-tolerance campaigns against violence, the promotion of non-violent communication, the prohibition of violent disciplinary practices, and the advancement of gender equality and non-discrimination are critical in raising awareness and driving sustained efforts to shift societal norms, values, and attitudes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval:\u003c/strong\u003e \u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University ... (Date: 06.03.2024/No: 03/08).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent:\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Hasan H\u0026uuml;seyin \u0026Ccedil;AM] and [Fadime Ustuner TOP]. The first draft of the manuscript was written by [Hasan H\u0026uuml;seyin \u0026Ccedil;AM] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all the students who participated in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgbaje, O. S., Nnaji, C. P., Nwagu, E. N., Iweama, C. N., Umoke, P. C. I., Ozoemena, L. E., \u0026amp; Abba, C. C. (2021). 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Adverse Childhood Experiences and the Health of University Students in Eight Provinces of Vietnam. \u003cem\u003eAsia-Pacific journal of public health\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(8 Suppl), 26S\u0026ndash;32S. https://doi.org/10.1177/1010539515589812\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024a). \u003cem\u003eAdverse Childhood Experiences International Questionnaire.\u003c/em\u003e https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq)\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024b). \u003cem\u003eWHO STEPwise Approach to Chronic Disease Risk-Factor Surveillance.\u003c/em\u003e https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps/manuals\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024c). \u003cem\u003eGlobal School-based Student Health Survey.\u003c/em\u003e https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-school-based-student-health-survey\u003c/li\u003e\n\u003cli\u003eXu, Z., Zhang, D., Ding, H., Zheng, X., Lee, R. C., Yang, Z., Mo, P. K., Lee, E. K., \u0026amp; Wong, S. Y. (2022). Association of positive and adverse childhood experiences with risky behaviours and mental health indicators among Chinese university students in Hong Kong: an exploratory study. \u003cem\u003eEuropean journal of psychotraumatology\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1), 2065429. https://doi.org/10.1080/20008198.2022.2065429\u003c/li\u003e\n\u003cli\u003eZhang, J., Tang, B. W., Liu, M. W., Yuan, S., Yu, H. J., Zhang, R., Huang, X. C., Nzala, S. H., Chikoya, M., Wang, P. G., \u0026amp; He, Q. Q. (2020). Association of Adverse Childhood Experiences with Health Risk Behaviors Among College Students in Zambia. \u003cem\u003eInternational journal of behavioral medicine\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(4), 400\u0026ndash;405. https://doi.org/10.1007/s12529-020-09863-y\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adverse childhood experiences, health, risk, students, Turkey","lastPublishedDoi":"10.21203/rs.3.rs-9117010/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9117010/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAdverse childhood experiences (ACEs) are potentially traumatic events occurring before the age of 18 that may have long-term consequences for health and well-being. This study aimed to examine the association between ACEs and health-risk behaviors (HRBs) among university students in Turkey. A cross-sectional web-based survey was conducted between April and June 2024 with 1,115 university students aged 18\u0026ndash;27 years. Data were collected using a structured self-report questionnaire assessing exposure to ACEs, including child maltreatment and household dysfunction, as well as a range of HRBs in young adulthood. Overall, 97.7% of participants reported experiencing at least one ACE, while 47.8% reported exposure to four or more ACEs. The most frequently reported ACEs were community violence (81.1%), emotional neglect (74.0%), emotional abuse (49.9%), witnessing violence against household members (39.2%), bullying (33.2%), and physical abuse (27.9%). A higher number of ACEs was significantly associated with several HRBs, including tobacco use, alcohol consumption, sedentary behavior, overweight and obesity, suicidal ideation, suicide attempts, interpersonal violence, and early sexual initiation (before age 16). These findings demonstrate a strong association between cumulative exposure to childhood adversity and multiple health-risk behaviors in young adulthood. The results highlight the need for trauma-informed public health strategies aimed at preventing ACEs and promoting resilience to reduce the long-term health consequences of childhood adversity.\u003c/p\u003e","manuscriptTitle":"Adverse Childhood Experiences and Associated Health-Risk Behaviors among University Students in Turkey: A Cross-Sectional Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-10 12:57:50","doi":"10.21203/rs.3.rs-9117010/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"836d00b5-91e3-4160-b2bb-a684c402eca9","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T08:17:18+00:00","index":17,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T11:35:53+00:00","index":16,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-10T12:57:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 12:57:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9117010","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9117010","identity":"rs-9117010","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}