Associations Between Adverse Childhood Experiences and Family Health in Adulthood: A National Cross-Sectional Analysis

Associations Between Adverse Childhood Experiences and Family Health in Adulthood: A National Cross-Sectional Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations Between Adverse Childhood Experiences and Family Health in Adulthood: A National Cross-Sectional Analysis Yang Ni, Shirong Li, Niuniu Sun, Yuqian Deng, zhenjie Yu, Lei Zha, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5959047/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Feb, 2026 Read the published version in Archives of Public Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background Whether Adverse childhood experiences (ACEs) influence family health relationships in adulthood remains an understudied area. The aim of this study was to assess the relationship between ACEs and family health and the mediating effect of socioeconomic status (SES) in adulthood. Method The 2023 PBICR was a national survey of 30,048 Chinese residents aged ≥ 18 years. We measured ACEs with the 7-item ACEs Questionnaire and family health with the Family Health Simplified Scale. Generalized linear models were used to explore the relationship between the number and type of ACEs with family health. The mediating effect of socioeconomic status (SES) in adulthood on the relationship between ACEs and family health was further examined. Result The most common type of ACEs in our study was emotional neglect (23.8%). All types of ACEs were negatively associated with family health. Of these, a history of incarceration (male: β= -4.51 (95% CI:-5.11 to -3.91; female: β= -3.18 (95% CI:-3.86 to -2.51), p < 0.0001), sexual abuse (male: β= -4.09 (95% CI:-4.53 to -3.65); female: (β= -2. 39, 95% CI:-2.80 to -1.98), P < 0.0001) and family mental illness (male: β= -3.95 (95% CI:-4.41 to -3.49); female: (β= -2.70, 95% CI:-3.15 to -2.25), P < 0.0001) were more significantly negatively associated with family health. However, there was a dose response between ACEs and family health in addition to family health resources. In addition, mediation analyses showed that the mediation proportion of SES in adulthood was only 2.15%, and ACEs participants with different residential, regional, and social characteristics had different family health performance. Conclusions The remote impact of early ACEs on family health suggests the need to integrate multidimensional interventions to reduce the long-term risk of childhood trauma and promote the health and well-being of family members. Contributions to the literature • For the first time, gender differences in family health outcomes associated with Adverse Childhood Experiences (ACEs) were quantified in a Chinese population, filling a regional research gap. Figures Figure 1 Contributions to the literature For the first time, gender differences in family health outcomes associated with Adverse Childhood Experiences (ACEs) were quantified in a Chinese population, filling a regional research gap. Strong associations between three key ACEs subtypes (a history of incarceration, sexual abuse, and family mental illness) and intergenerational family dysfunction. Weak buffering effect of socioeconomic status in adulthood on the intergenerational transmission of affect in ACEs. Culturally adapted screening mechanisms for ACEs and gender-differentiated family intervention programs in Chinese public health policy. Background Adverse Childhood Experiences (ACEs) represent a prevalent global issue rooted in dysfunctional early childhood environments. Among 546,458 adult participants, approximately six out of ten reported at least one ACE, including abuse, domestic violence, caregiver mental illness, and substance abuse. 1 Cumulative ACE exposure significantly increases the risk of chronic diseases, cardiovascular issues, cancer, and depression, while decreasing well-being, prosocial behavior, and family intimacy. ACEs also correlate with harmful behaviors like alcohol abuse, smoking, and sleep disorders. 2 , 3 The family, as a confluence of biological, legal, and emotional connections, transmits its health status intergenerationally and is influenced by the health of the family of origin and the dynamics of extended kinship. Family health is a holistic concept encompassing the physical, social, emotional, economic, and medical well-being of all its members. It goes beyond individual characteristics or economic indicators, focusing on factors like social/emotional support, healthy lifestyle adoption, economic stability, and access to healthcare. 4 High levels of family health management can significantly mitigate psychological and behavioral issues. 5 In China, deeply rooted familial values facilitate the transmission and sharing of healthy behaviors, awareness, and capabilities among family members. The COVID-19 pandemic highlighted this dynamic, as the exchange of information strengthened family health, bolstering resilience and promoting overall well-being. 6 The Life Course Health Development (LCHD) model integrates life course, biomedical, and biopsychosocial perspectives to explore the complexity and non-linear nature of individual health trajectories. It highlights how these trajectories are influenced by environment, time, and social structures, 7 particularly during childhood, adolescence, and early adulthood. 8 ACEs within the family can disrupt a child's developmental trajectory, increasing health risks in adulthood. Research indicates that children from families with positive communication are at lower risk of ACEs. 9 , 10 Family development is a lifelong process involving changes across multiple life stages, including marital relationships, parenting roles, employment, and responsibilities like caring for aging parents or coping with chronic diseases. As children transition into adulthood, their roles and responsibilities evolve, and the family of origin acts as the "health leader," shaping and transmitting various family responsibilities. Individuals who have experienced ACEs may develop a "pattern of pronounced disadvantage," 11 with adversities complicating the family environment, leading to poor communication, escalating disagreements, and hostile conflicts. 12 Conversely, the LCHD model also suggests that health development is adaptive, promoting resilience and plasticity despite adverse environments. 13 Not all individuals who experience ACEs respond negatively; some may seek improvement, maintaining hope and optimism. 14 Previous research has highlighted the importance of early life conditions in shaping life course outcomes, particularly during the first two decades of life, when socioeconomic health inequalities significantly impact adult health. 15 , 16 Both ACEs and negative childhood socioeconomic conditions are associated with poor life course outcomes. 17 However, some studies suggest that the relationship between ACEs and health outcomes does not show significant differences across socioeconomic status (SES) groups. 18 Despite this, the role of SES in adulthood, particularly whether higher SES can mitigate the negative effects of ACEs on family health, remains unclear. According to the LCHD model, SES in adulthood may moderate the cumulative effects of ACEs and shape family health trajectories. Further research is needed to clarify how higher SES may buffer the impact of ACEs on family health. Current research on the impact of ACEs on family health is relatively scarce. Previous studies indicate gender differences in the impact of ACEs on psychological and behavioral health, with varying results across populations and cultural contexts. 19 , 20 This study uses nationally representative data to analyze the impact of ACEs on family health in adulthood, stratified by gender and examining regional differences. Additionally, we will explore the mediating effect of SES in adulthood on the relationship between ACEs and family health and assess whether sociodemographic factors modify this relationship. Methods Data and study participants Data for this study were sourced from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey conducted from June 20 to August 31, 2023, using a multistage probability sampling strategy. 21 Participants were randomly selected from 34 provinces/regions of mainland China (excluding Taiwan) and the Hong Kong and Macau Special Administrative Regions, covering 150 cities, 202 districts/counties, 390 townships/streets, and 800 communities. Quota sampling, based on the 2021 Seventh National Population Census, ensured the sample reflected gender and age distributions of the population. Inclusion criteria were: age ≥ 18 years, Chinese nationality, residing in China (≤ 1 month/year outside), ability to complete the online questionnaire independently or with assistance, and comprehension of the questionnaire items. Exclusion criteria included individuals with cognitive impairments, psychiatric disorders, or participation in similar studies, as well as those unwilling to participate. The adjusted sample size was 30,054, with a final sample of 30,048 after excluding 6 questionnaires of unknown origin. Trained interviewers distributed questionnaires to participants via an online survey platform ( https://www.wjx.cn/ ), obtained informed consent from each participant, and recorded the questionnaire IDs assigned to them, ensuring privacy and confidentiality. Family Health This study was based on the Family Health Scale-Short Form (FHS-SF) established by scholar Alice Ann Crandall, 22 modified and adjusted to fit the context and cultural characteristics of China. The revised FHS-SF includes four dimensions and ten items: "Family Social/Emotional Health" (α = 0.88), "Healthy Family Lifestyle" (α = 0.84), "Family Health Resources" (α = 0.75), and "External Family Social Support" (α = 0.75). All questions were answered using a 5-point Likert scale, ranging from "strongly disagree" to "strongly agree" (scored 1 to 5). The negatively worded items under "Family Health Resources" were reverse scored ("strongly agree" = 1), resulting in a total score range of 10 to 50, with higher scores indicating better family health. The FHS-SF demonstrated good reliability and validity (α = 0.81). Adverse Childhood Experiences In this study, we used the ACEs scale from the Behavioral Risk Factor Surveillance System (BRFSS) to assess whether participants experienced seven types of adversity before the age of 18: physical abuse, emotional abuse, sexual abuse, household mental illness, substance abuse, domestic violence, and having a family member with a history of incarceration. Each type of adversity was dichotomized (0 = not experienced, 1 = experienced), and the scores were summed to generate a total ACE score ranging from 0 to 7, with higher scores indicating greater exposure to adversity. For further analysis, we categorized the total ACE score into five groups: 0, 1, 2, 3, and 4 or more. Socioeconomic status in adulthood SES in adulthood was classified using the Li's Chinese Urban Residents Scale, which measures the quantity of social resources an individual can access or control. 23 This scale includes eight levels of monthly household income, six levels of educational attainment, and six levels of occupational status. These items were aggregated into a cumulative SES score ranging from 3 to 20, with higher scores indicating higher SES. The scores were categorized into three levels based on quartiles: low SES (≤ 9), middle SES (10–12), and high SES (≥ 13), as shown in Supplementary Table S1. Sociodemographic variables The questionnaire collected data on the following variables: age (18–44, 45–64, 65 + years), sex (male, female), ethnicity (Han, minorities), religious beliefs (no, yes), marital status (unmarried, married, divorced/widowed), social health insurance (no, yes), family type (including Nuclear/main/joint, couple's, single-parent, split-generation, and other forms), and diagnosed chronic conditions (0, 1, 2 or more). Considering the regional disparities in socioeconomic development in China, 24 residents of more developed areas and urban settings likely possess higher health capital. 25 We also collected information on the respondents' residence (rural or urban) and region (eastern developed, central developing, western underdeveloped). Health behaviors were assessed, including alcohol drinking (no, yes) and smoking (no, yes). Statistical Analysis Chi-square tests and rank-sum tests were used to compare demographic characteristics stratified by gender. To identify potential confounders, we reviewed relevant literature and conducted univariate analyses, then created a Directed Acyclic Graph (DAG) to illustrate the main relationships between independent variables, dependent variables, covariates, and mediating variables (Supplementary Fig S1). After identifying the confounders, we separately applied generalized linear regression to estimate the standardized coefficients (β) and 95% confidence intervals (CI) for the associations between the number and types of ACEs and family health. Two models were established: Model 1 was unadjusted, while Model 2 adjusted for age, gender, ethnicity, marital status, religious beliefs, social health insurance, family type, diagnosed chronic conditions, residence, region, and health behaviors (alcohol consumption, smoking). To further explore potential mechanisms, we used the Bootstrap method to test whether SES in adulthood mediated the relationship between ACEs and family health. To address intergroup differences, overlap weighting propensity score (OWPS) matching was employed to compare the associations between participants with and without ACEs and family health. Propensity scores were calculated based on the aforementioned confounders, and generalized linear models were re-applied to ensure the robustness of the results. All statistical analyses were performed using R statistical software (version 4.3.1), with a two-tailed p-value < 0.05 considered statistically significant. Ethical considerations This study has passed the ethical review of Shandong Provincial Hospital (SWYX: NO.2023 − 198) and has been registered as a study in China Clinical Trial Registry (ChiCTR2300072573). All respondents volunteered to participate and were informed of the details of the study prior to the survey. Written informed consent was obtained from all respondents and they were assured of confidentiality. Results Table 1 presents the baseline characteristics of the 30,048 study participants from the 2023 PBICR. The sample comprised 15,038 female and 15,010 male. On average, the family health score was 39.52 ± 6.25 for male and 40.20 ± 6.02 for female. The prevalence of each ACE type ranged from 4.2% (family member with a history of incarceration) to 23.8% (emotional neglect). Male exhibited higher prevalence rates for specific ACE types, such as physical abuse, household substance abuse, and family member incarceration history, compared to female. Regarding the cumulative number of ACEs, 11.3% of participants experienced exactly one ACE, while 4.0% experienced four or more ACEs. Table 1 Basic Characteristics of Participants by Gender, PBICR, 2023 Variable Total (n = 30 048) Male (n = 15 010) Female (n = 15 038) P value Age (%) 0.885 18–45 16 687(55.5) 8 339(55.5) 8 343(55.4) 46–64 9 344(31.1) 4 651(31.0) 4 693(31.2) ≥65 4 022(13.4) 2 020(13.5) 2 002(13.4) Ethnicity (%) 0.466 Han 27 295(90.8) 13 653(91.0) 13 642(90.7) Minorities 2 753(9.2) 1 357(9.0) 1 396(9.3) Marital status (%) < 0.001 Unmarried 8 897(29.6) 4 731(31.6) 4 166(27.7) Married 1 9424(64.6) 9 537(63.5) 9 887(65.8) Divorced/widowed 1 727(5.8) 742(4.9) 985(6.5) family type (%) < 0.001 Nuclear/main/ joint family 22 431(74.7) 11 062(73.7) 11 369(75.6) Couple's family 4 965(16.5) 2 638 (17.6) 2 327(15.5) Single-parent family 1 087(3.6) 499(3.3) 588(3.9) Split-generation family 173(0.6) 80(0.5) 93(0.6) Other families 1 392(4.6) 731(4.9) 661(4.4) Diagnosed chronic conditions (%) < 0.001 0 20 455(68.1) 10 017(66.7) 10 438(68.1) 1 5 811(19.3) 2 993(19.9) 2 818(18.7) 2 or more 3 782(12.6) 2 000(13.3) 1 782(11.8) Social health insurance (%) 0.288 No 1 440(4.8) 739(4.9) 701(4.7) Yes 28 608(95.2) 14 271(95.1) 14 337(95.3) Religious beliefs (%) < 0.001 No 27 760(92.4) 13 951(92.9) 13 809(91.8) Yes 2 288(7.6) 1 059(7.1) 1 229(8.2) Individual health behavior Alcohol drinking (%) 0.0001 No 19 227(64.0) 7 089(47.2) 12 138(80.7) Yes 10 821(36.0) 7 921(52.8) 2 900(19.3) Smoking (%) 0.0001 No 23 877(79.5) 9 554(63.7) 14 323(95.2) Yes 6 171(20.5) 5 456(36.3) 715(4.8) Region (%) 0.010 Eastern 11 793(39.3) 5 982(39.9) 5 811(38.6) Central 6 587(21.9) 3 188(21.2) 3 399(22.6) Western 11 668(38.8) 5 840(38.9) 5 828(38.8) Residency (%) 0.907 Rural 9 318(31.0) 4 650(31.0) 4 668(31.0) Urban 20 730(69.0) 10 360(69.0) 10 370(69.0) Socioeconomic Status (%) < 0.001 High SES 10 273(34.2) 4 541(30.3) 5 732(38.2) Medium SES 10 381(34.5) 5 397(35.9) 4 984(33.1) Low SES 9 394(31.3) 5 072(33.8) 4 322(28.7) Dependent variables (M ± SD) a < 0.001 Family health 39.86 ± 6.14 39.52 ± 6.25 40.20 ± 6.02 Independent variables (%) Prevalence of ACEs < 0.001 No ACEs 22 243(74.0) 11 059(73.7) 11 184(74.4) 1 ACEs 3 394(11.3) 1 625(10.8) 1 769(11.8) 2 ACEs 1 975(6.6) 1 067(7.1) 908(6.0) 3 ACEs 1 239(4.1) 620(4.1) 619(4.1) 4 or more ACEs 1 197(4.0) 639(4.3) 558(3.7) Specific ACEs Physical abuse 4 038(23.8) 2 181(24.8) 1 857(22.8) < 0.001 Emotional abuse 4 319(25.5) 2 133(24.2) 2 186(26.9) 0.421 Genderual abuse 1 650(9.7) 795(9.0) 855(10.5) 0.139 Household substance misuse 2 112(12.6) 1 175(13.3) 937(11.5) < 0.001 Household mental illness 1 446(8.5) 731(8.3) 715(8.8) 0.64 Household domestic violence 2 664(15.7) 1 381(15.7) 1 283(15.8) 0.041 Incarcerated household member 713(4.2) 412(4.7) 301(3.7) < 0.001 Continuous variables were presented as mean ± SE. Categorical variables were presented as n (%). ACEs: adverse childhood experiences. b Kruskal-Wallis test. Table 2 illustrates the relationship between the number and types of ACEs and family health, categorized by gender. In the crude model, there was a clear negative association between the number of ACEs and family health, using those with no ACEs as a reference. For male, experiencing one ACE did not significantly affect family health. In the adjusted Model 2, controlling for demographics, all types of ACEs were significantly linked to poorer family health outcomes. Specifically, male showed pronounced negative associations with family health from having a family member with a history of incarceration (β = -4.51, 95% CI: -5.11 to -3.91, p < 0.0001), sexual abuse (β = -4.09, 95% CI: -4.53 to -3.65, p < 0.0001), and household mental illness (β = -3.95, 95% CI: -4.41 to -3.49, p < 0.001). Similarly, female exhibited significant negative associations with family health from family member incarceration (β = -3.18, 95% CI: -3.86 to -2.51, p < 0.0001), household mental illness (β = -2.70, 95% CI: -3.15 to -2.25, p < 0.001), and sexual abuse (β = -2.39, 95% CI: -2.80 to -1.98, p < 0.0001). Both genders also showed weaker but significant associations between emotional abuse (males: β = -1.89, 95% CI: -2.17 to -1.61, p < 0.0001; females: β = -1.74, 95% CI: -2.01 to -1.48, p < 0.0001) and physical abuse (males: β = -1.98, 95% CI: -2.26 to -1.70, p < 0.0001; females: β = -2.23, 95% CI: -2.52 to -1.94, p < 0.0001) with family health. Table 2 Association between adverse childhood experiences (ACEs) and family health. Variable Male Female Model 1 a Model 2 b Model 1 a Model 2 b Prevalence of ACEs No ACEs 1 c 1 c 1 c 1 c 1 ACEs -0.28(-0.59,0.04) -0.23(-0.54,0.08) -0.54(-0.83, -0.24) *** -0.36(-0.65, -0.07) * 2 ACEs -1.38(-1.76, -1.00) *** -1.18(-1.55, -0.80) *** -1.45(-1.85, -1.06) *** -1.16(-1.55, -0.77) *** 3 ACEs -1.56(-2.05, -1.07) *** -1.31(-1.80, -0.83) *** -2.25(-2.72, -1.77) **** -1.74(-2.20, -1.27) *** 4 or more ACEs -6.91(-7.40, -6.43) **** -5.89(-6.38, -5.39) **** -6.51(-7.01, -6.02) **** -5.10(-5.61, -4.59) **** Specific ACE Physical abuse -2.46(-2.74, -2.18) **** -1.98(-2.26, -1.70) **** -2.93(-3.21, -2.64) **** -2.23(-2.52, -1.94) **** Emotional abuse -2.33(-2.62, -2.05) **** -1.89(-2.17, -1.61) **** -2.28(-2.55, -2.01) **** -1.74(-2.01, -1.48) **** Genderual abuse -4.95(-5.39, -4.51) **** -4.09(-4.53, -3.65) **** -3.15(-3.56, -2.73) **** -2.39(-2.80, -1.98) **** Household substance misuse -3.38(-3.75, -3.01) **** -2.27(-3.03, -2.29) **** -3.50(-3.89, -3.10) **** -2.30(-2.70, -1.91) **** Household mental illness -3.78(-4.22, -3.33) **** -3.95(-4.41, -3.49 ) **** -4.80(-5.26, -4.35) **** -2.70(-3.15, -2.25) *** Household domestic violence -3.21(-3.55, -2.87) **** -2.68(-3.02, -2.34) *** -3.28(-3.62, -2.94) **** -2.27(-2.62, -1.93) ** Incarcerated household member -4.80(-5.49, -4.12) **** -4.51(-5.11, -3.91) **** -5.69(-6.29, -5.08) **** -3.18(-3.86, -2.51) **** β: standardized coefficient, CI: confidence interval, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001, statistically significant in bold. a Model 1 was the crude model. b Model 2 was adjusted for age, gender, ethnicity, marital status, age, gender, marital status, family type, diagnosed chronic conditions, social health insurance, religious beliefs, alcohol drinking, smoking, residency, region. c Reference: No ACEs exposure. Table 3 shows the relationship between the cumulative number of ACEs and subdimensions of family health. In the adjusted Model 2, both male and female who experienced four or more ACEs had significant negative associations with family social/emotional support (males: β = -2.65, 95% CI: -2.84 to -2.46; females: β = -2.53, 95% CI: -2.73 to -2.34, p < 0.0001). However, among participants who experienced four or more ACEs, the association with family health resources was negative but not statistically significant. Table 3 Association of No. of adverse childhood experiences (ACEs) with sub-dimensions of family health Variable β (95% CI) by No. of ACEs Male Female 0 c 1 2 3 ≥ 4 0 c 1 2 3 ≥ 4 Model 1 a Family social and emotional health processes 1 -0.25(0.37,0.13) *** -0.70(-0.84, -0.55) **** -0.92(-1.10, -0.73) **** -3.02(-3.20, -2.84) **** 1 -0.48(-0.59, -0.37) **** -0.92(-1.07, -0.77) **** -1.15(-1.33, -0.97) **** -3.09(-3.28, -2.90) **** Family healthy lifestyle 1 -0.10(0.18,0.02) *** -0.27(-0.37, -0.17) *** -0.46(-0.58, -0.33) *** -1.93(-2.06, -1.81) **** 1 -0.22(-0.29, -0.14) *** -0.40(-0.50, -0.30) *** -0.56(-0.68, -0.44) **** -1.80(-1.93, -1.67) **** Family health resources 1 0.20(0.03,0.37) * -0.22(-0.42, -0.01) * 0.06(-0.20,0.32) -0.43(-0.69,0.17) *** 1 0.24(0.09,0.39) ** 0.09(-0.12,0.29) -0.29(-0.54, -0.05) ** -0.41(-0.66, -0.15) ** Family external social supports 1 -0.13(0.21,0.04) *** -0.19(-0.30, -0.09) *** -0.24(-0.38, -0.11) **** -1.53(-1.67, -1.40) **** 1 -0.08(-0.16,0.002) -0.22(-0.33, -0.11) *** -0.24(-0.37,0.11) **** -1.22(-1.35, -1.09) **** Model 2 b Family social and emotional health processes 1 -0.23(0.35,0.12) *** -0.61(-0.76, -0.47) **** -0.80(-0.99, -0.62) **** -2.65(-2.84, -2.46) **** 1 -0.39(-0.50, -0.28) *** -0.78(-0.92, -0.63) **** -0.94(-1.11, -0.76) **** -2.53(-2.73, -2.34) **** Family healthy lifestyle 1 -0.10(-0.18, -0.02) * -0.24(-0.34, -0.14) *** -0.40(-0.53, -0.28) *** -1.70(-1.83, -1.57) **** 1 -0.18(-0.25, -0.11) *** -0.34(-0.44, -0.24) *** -0.46(-0.58, -0.34) *** -1.45(-1.59, -1.32) **** Family health resources 1 0.20(0.04,0.37) * -0.22(-0.43, -0.02) * 0.003(-0.43,0.26) -0.24(-0.50,0.03) 1 0.20(0.05,0.35) ** 0.04(-0.16,0.25) -0.32(-0.57, -0.08) ** -0.27(-0.54,0.003) Family external social supports 1 -0.12(0.21,0.04) ** -0.16(-0.26, -0.05) ** -0.16(-0.29, -0.03) * -1.26(-1.39, -1.13) **** 1 -0.05(-0.13,0.03) -0.16(-0.27, -0.06) ** -0.12(-0.25,0.004) -0.86(-1.00, -0.72) **** β: standardized coefficient, CI: confidence interval, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001, statistically significant in bold. a Model 1 was the crude model. b Model 2 was adjusted for age, gender, ethnicity, marital status, age, gender, marital status, family type, diagnosed chronic conditions, social health insurance, religious beliefs, alcohol drinking, smoking, residency, region. c Reference: No ACEs exposure. After adjusting for demographic characteristics, the mediating effect of adulthood SES on the ACEs-family health relationship was modest. The coefficient for the effect of ACEs on adulthood SES was − 0.08 (Supplementary Fig S2), while the coefficient for the effect of adulthood SES on family health was 0.26. Approximately 2.15% of the impact of ACEs on family health was mediated through adulthood SES (p < 0.001). The cumulative number of ACEs was negatively associated with family health across all regions. Urban residents generally reported higher average family health scores than rural residents (Supplementary Fig S3a). For ACE ≥ 4, scores were 32.74 ± 6.81 in rural areas and 34.19 ± 7.13 in urban areas. While both urban and rural populations showed negative correlations between the number of ACEs and family health, no significant association was observed for 1–2 ACEs among rural residents (Supplementary Table S2). Regionally, participants from the eastern region without ACE exposure had the highest family health scores (40.35 ± 5.83). However, with an increasing number of ACEs, particularly ≥ 4, family health scores in the eastern region were lower than in the central and western regions (32.92 ± 7.11 vs. 33.77 ± 7.17 and 34.90 ± 6.27, respectively; Supplementary Fig S3b). A stepwise negative association was observed between the number of ACEs and family health across regions (Eastern: β = -6.51, 95% CI: -7.09 to -5.93; Central: β = -5.05, 95% CI: -5.90 to -4.19; Western: β = -5.30, 95% CI: -5.83 to -4.76, P < 0.001), with no significant association for one ACE in the western region. In this study, 7,805 participants (26.0%) experienced ACEs, with an equal gender distribution. The adjusted model revealed significant associations between social characteristics and family health among individuals exposed to ACEs. Specifically, family health was poorer among males aged 18–45 (β = -0.55, 95% CI: -1.04 to -0.07, P < 0.05), those who were divorced or widowed (β = -1.06, 95% CI: -1.94 to -0.18, P < 0.05), and individuals living in intergenerational households (β = -2.43, 95% CI: -4.31 to -0.55, P < 0.01). Additionally, participants with low SES (males: β = -0.93, 95% CI: -1.37 to -0.49; females: β = -1.48, 95% CI: -1.92 to -1.05, P < 0.001), those living in couple families (males: β = -2.01, 95% CI: -2.54 to -1.49; females: β = -1.11, 95% CI: -1.69 to -0.53, P < 0.001), or other family types (males: β = -1.79, 95% CI: -2.57, -1.01; females: β = -1.51, 95% CI: -2.23 to -0.72, P < 0.001) reported significantly lower family health. Conversely, individuals with high SES reported better family health (males: β = 1.29, 95% CI: 0.97 to 1.61; females: β = 1.59, 95% CI: 1.13 to 2.06, P < 0.001). Weights were calculated for participants with and without ACEs using the Overlap Weighting (OW) method, which reflects the probability of being assigned to the opposite group. 26 The distribution of propensity scores for ACEs before and after adjustment is shown in Supplementary Fig S4. Among individuals with similar social characteristics and SES, ACEs are significantly negatively associated with family health across all subdimensions except for family health resources (Supplementary Table S3). Discussion The family environment is complex and dynamic, influenced by evolving factors and historical risks that accumulate over time, impacting its stability. Our sensitivity analysis reaffirmed key findings: exposure to ACEs correlates negatively with family health in adulthood. We observed a significant dose-response relationship between the number of ACEs and family health, though family health resources showed no such association. Moreover, the impact of ACEs on family health varied across different regions. Particularly notable was the heightened negative impact of ACEs on family health among individuals in couple or other family types, those with low SES, and those managing multiple chronic conditions. This national study offers a fresh perspective on understanding how ACEs affect family health. Despite ACEs types in our study having prevalence rates similar to global estimates, overall incidence was relatively low. 27 Differences in sample selection and measurement methods across studies limit comparability between countries. Furthermore, social and cultural differences may influence reporting behavior, such as Confucian values emphasizing interpersonal harmony, may lead Chinese participants to underreport adversities to avoid stigma. 28 High rates of physical and emotional abuse found in our study align with patterns observed in other East Asian countries, 29 possibly influenced by the "tiger parenting" style emphasizing discipline for academic success and family honor. 30 Boys in patriarchal traditions may face stricter discipline due to higher expectations. 31 Existing research consistently indicates that ACEs are associated with poorer family health outcomes in adulthood. 32 These include experiences such as family member incarceration, sexual abuse, and family mental illness, which disrupt internal family attachment relationships and hinder individuals' ability to form deep emotional connections, especially in intimate relationships. These experiences often carry stigma, leading to social exclusion and discrimination, further weakening emotional bonds within the family. 33 From a family health perspective, ACEs show the strongest negative correlation with social and emotional support. Epigenetic studies have demonstrated that ACEs can influence gene expression through chemical modifications that accelerate cellular aging, particularly affecting brain development during early childhood. 34 Such changes can have lasting effects on brain structures, impacting executive function, attention, cognition, memory, and emotional integration abilities. Psychologically, individuals who have experienced ACEs often develop coping strategies that may limit their ability to seek diverse and effective mechanisms for managing family health issues. 35 Research indicates persistent low levels of mental health among adults with a history of ACEs, affecting prosocial behaviors and relationships, including difficulties in forming close bonds and a preference for solitude. 36 Contrary to previous findings, 32 this study did not find a significant association between ACEs and family health resources. This may be due to China's universal basic healthcare system, which ensures timely treatment and fosters trust in healthcare providers, thus providing essential health resources for families. Additionally, this study confirmed the protective role of high SES in adulthood on family health and highlighted its significant yet modest mediating effect in the relationship between (ACEs and family health. These findings suggest that interventions aimed at improving SES in adulthood may partially mitigate the detrimental impact of ACEs on family health. However, the relatively small proportion of the mediating effect may be attributed to the lower prevalence of ACEs among individuals with high SES and the pronounced direct impact of ACEs on family health. This underscores the importance of family-centered intervention strategies, particularly those addressing psychological distress and complex dynamics within the family environment. Future interventions should integrate family-level factors and processes more comprehensively to effectively prevent or alleviate the negative effects of ACEs on family health in adulthood and to meet the diverse needs of vulnerable family systems. Residents who have experienced ACEs in different social environments exhibit disparities in family health. ACEs are more prevalent in economically underdeveloped areas, 37 impacting residents differently based on regional health resources. Compared to economically developed and urban areas in China, western and rural regions face uneven public resource allocation, 38 potentially leading to weaker health awareness and higher poverty levels, affecting family regulation and health management. 39 However, ACEs in rural areas don't necessarily compromise family health, these environments may support stable family development through shared family dinners, supportive communities, and lower life stress. 40 In subgroup analyses, ACEs within married or nuclear family types may influence conflict management in intimate relationships, potentially leading to avoidance, aggression, or silent treatment that impacts family dynamics or parent-child relationships. (Amone-P'Olak, 2022) ACEs survivors facing low SES in adulthood and multiple chronic diseases endure environmental pressures hindering their ability to care for family members, challenging family functioning. ACEs survivors with similar social characteristics exhibit gender differences in family health. Men tend to experience higher allostatic load in response to chronic stressors, leading to greater psychological distress and compromised quality of life. 41 Aging may equip individuals with coping strategies to manage life stressors, potentially improving family health outcomes over time. 42 Therefore, it is plausible to further explain that older ACEs survivors may exhibit better family health due to the accumulation of long-term life experiences and coping strategies. This study has several limitations. Firstly, although our sample is representative of China, it does not include individuals aged 17 and below, limiting the generalizability and applicability of the study results. Secondly, collecting data on experiences before the age of 18 retrospectively may introduce recall bias. But previous studies have reported that self-reported ACEs remain reasonably reliable over time. 43 Lastly, this study employs a cross-sectional design, which cannot establish causality between ACEs and family health. Future research may utilize longitudinal data to delve deeper into the association between ACEs and family health. Conclusion This study, based on a nationally representative adult population, reveals a significant dose-response relationship between ACEs and family health in adulthood, except for family health resources. Utilizing the LCHD model, we gained deeper insights into the long-term impacts of early ACEs on family health, which are intertwined with individual characteristics and social environments. Factors such as marriage, family type, chronic conditions, and SES in adulthood significantly modify this relationship. The high adaptability of family health highlights the critical importance of preventing ACEs and integrating interventions at the individual, family, and community levels. This aligns with global action plans advocated by various national sectors in response to the WHO's global action plan, emphasizing the promotion of health and well-being among family members. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Shandong Provincial Hospital (Approval No. SWYX: 2023-198) and registered with the China Clinical Trial Registry (Registration No. ChiCTR2300072573). Written informed consent was obtained from all participants prior to their involvement in the study. Consent for publication Not applicable. Availability of data and materials To protect participant confidentiality, the raw dataset contains identifiable information and is therefore not publicly available. De-identified data supporting the findings can be requested from the corresponding author (Yibo Wu, [email protected] ) following approval from the Shandong Provincial Hospital Ethics Committee. Competing interests The authors declare no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. Authors' contributions YN and SL contributed equally to this work. YN conceptualized the study, curated data, conducted formal analyses, and drafted the original manuscript. SL developed the methodology, performed validation procedures, and created visualizations. NS conducted investigations and managed research resources. YD implemented software solutions and performed data validation. ZY oversaw project administration. LZ provided supervisory guidance. YW contributed to study conceptualization and critically revised and edited the manuscript. All authors reviewed and approved the final submitted version. Acknowledgements We extend our gratitude to all participants in the Psychology and Behavior Investigation of Chinese Residents project. Authors' information Yang Ni1#, Shirong Li2#, Niuniu Sun3, Yuqian Deng4, Zhenjie Yu5, Lei Zha6, Yibo Wu7* 1 Department of Gynecology and Obstetrics, Wuhu Conch Hospital - Anhui, China 2 Department of Respiratory Medicine, Wuhu Hospital Affiliated to East China Normal University - Anhui, China 3 School of Nursing, Henan University of Science and Technology - Henan, China 4 Xiangya School of Nursing, Central South University – Hunan, China 5 School of Nursing, Tianjin Medical University - TianJin, China 6 Respiratory Medicine Care Unit, Yijishan Hospital of Wannan Medical College - Anhui, China 7 School of Public Health, Peking University - Beijing, China # Yang Ni and Shirong Li are co-first authors, and they contributed equally to this work. *Corresponding author name and email address: Yibo Wu - [email protected] . References Madigan S, Deneault AA, Racine N, et al. Adverse childhood experiences: a meta-analysis of prevalence and moderators among half a million adults in 206 studies. 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Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK. PLoS Med. Mar 2020;17(3):e1003031. 10.1371/journal.pmed.1003031 . Sahle BW, Reavley NJ, Li W, et al. The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses. Eur Child Adolesc Psychiatry Oct. 2022;31(10):1489–99. 10.1007/s00787-021-01745-2 . Le T, Dang HM, Weiss B. Prevalence of adverse childhood experiences among Vietnamese high school students. Child Abuse Negl Jun. 2022;128:105628. 10.1016/j.chiabu.2022.105628 . Liu D, Fan S, Huang X. Study protocol: A national cross-sectional study on psychology and behavior investigation of Chinese residents in 2023, PBICR. medRxiv . 2024:2024.03.28.24305038. 10.1101/2024.03.28.24305038 Crandall A, Weiss-Laxer NS, Broadbent E, et al. The Family Health Scale: Reliability and Validity of a Short- and Long-Form. Front Public Health. 2020;8:587125. 10.3389/fpubh.2020.587125 . Li Q. Social class in current China: measurement and analysis. Beijing: Beijing Normal University. ;; 2010. (in Chinese). Yao Q, Zhang X, Wu Y, Liu C. Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study. BMJ Glob Health Nov. 2023;30(11). 10.1136/bmjgh-2023-013350 . Jia C, Long Y, Luo X, Li X, Zuo W, Wu Y. Inverted U-shaped relationship between education and family health: The urban-rural gap in Chinese dual society. Front Public Health. 2022;10:1071245. 10.3389/fpubh.2022.1071245 . Li F, Thomas LE, Li F. Addressing Extreme Propensity Scores via the Overlap Weights. Am J Epidemiol Jan. 2019;1(1):250–7. 10.1093/aje/kwy201 . Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA, van Ijzendoorn MH. The prevalence of child maltreatment across the globe: Review of a series of meta‐analyses. Child Abuse Rev. 2015;24(1):37–50. 10.1002/car.2353 . Ye D, Reyes-Salvail F. Adverse childhood experiences among Hawai'i adults: Findings from the 2010 Behavioral Risk Factor Survey. Hawaii J Med Public Health Jun. 2014;73(6):181–90. Tran NK, van Berkel SR, van Alink IMH. Child and Family Factors Associated With Child Maltreatment in Vietnam. J Interpers Violence Mar. 2021;36(5–6):NP2931–53. 10.1177/0886260518767914 . Lui PP, Rollock D. Tiger mother: popular and psychological scientific perspectives on Asian culture and parenting. Am J Orthopsychiatry Oct. 2013;83(4):450–6. 10.1111/ajop.12043 . Wang M, Liu L. Parental harsh discipline in mainland China: prevalence, frequency, and coexistence. Child Abuse Negl Jun. 2014;38(6):1128–37. 10.1016/j.chiabu.2014.02.016 . Daines CL, Hansen D, Novilla MLB, Crandall A. Effects of positive and negative childhood experiences on adult family health. BMC Public Health Apr. 2021;5(1):651. 10.1186/s12889-021-10732-w . Wiens K, Gillis J, Nicolau I, Wade TJ. Capturing Risk Associated with Childhood Adversity: Independent, Cumulative, and Multiplicative Effects of Physical Abuse, Sexual Abuse, and Family Violence on Mental Disorders and Suicidality. Perm J. 2020;24doi. 10.7812/tpp/19.079 . Giotakos O. Neurobiology of emotional trauma. Psychiatriki Apr-Jun. 2020;31(2):162–71. 10.22365/jpsych.2020.312.162 . van Der Kolk B, Ford JD, Spinazzola J. Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial. Eur J Psychotraumatol. 2019;10(1):1562841. 10.1080/20008198.2018.1562841 . Li SM, Zhang C, Bi K, Chen MS. Longitudinal impacts of adverse childhood experiences on multidimensional health outcomes: Predicting trajectories in mental, physical, and behavioral health. Child Abuse Negl Nov. 2023;16:106543. 10.1016/j.chiabu.2023.106543 . Yau MY, Ge S, Moss HB, et al. Regional prevalence of adverse childhood experiences in the United States using a nationally representative school-based sample. SSM Popul Health Sep. 2022;19:101145. 10.1016/j.ssmph.2022.101145 . Dong E, Xu J, Sun X, Xu T, Zhang L, Wang T. Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China. Arch Public Health May. 2021;17(1):78. 10.1186/s13690-021-00597-1 . Long Y, Jia C, Luo X, et al. The Impact of Higher Education on Health Literacy: A Comparative Study between Urban and Rural China. Sustain 09/25. 2022;14:12142. 10.3390/su141912142 . Radcliff E, Crouch E, Strompolis M. Rural-urban differences in exposure to adverse childhood experiences among South Carolina adults. Rural Remote Health Feb. 2018;18(1):4434. 10.22605/rrh4434 . Guidi J, Lucente M, Sonino N, Fava Giovanni A. Allostatic Load and Its Impact on Health: A Systematic Review. Psychother Psychosom. 2020;90(1):11–27. 10.1159/000510696 . Sütterlin S, Paap MC, Babic S, Kübler A, Vögele C. Rumination and age: some things get better. J Aging Res. 2012;2012:267327. 10.1155/2012/267327 . Wielaard I, Stek ML, Comijs HC, Rhebergen D. Reliability of retrospective reports on childhood abuse and its determinants in older adults during a 6-year follow-up. J Psychiatr Res Oct. 2018;105:9–16. 10.1016/j.jpsychires.2018.08.009 . Additional Declarations No competing interests reported. Supplementary Files figureandtablesupplements.docx Cite Share Download PDF Status: Published Journal Publication published 27 Feb, 2026 Read the published version in Archives of Public Health → Version 1 posted Editorial decision: Revision requested 06 Sep, 2025 Reviews received at journal 05 Sep, 2025 Reviewers agreed at journal 29 Aug, 2025 Reviews received at journal 15 Aug, 2025 Reviewers agreed at journal 27 Jul, 2025 Reviewers invited by journal 30 Apr, 2025 Editor assigned by journal 19 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 04 Feb, 2025 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. 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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-5959047","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451622502,"identity":"99a78d45-3cd6-4de3-97c1-fa380607b166","order_by":0,"name":"Yang Ni","email":"","orcid":"","institution":"Wuhu Conch Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Ni","suffix":""},{"id":451622503,"identity":"e3d09b6e-5c1d-4b16-a7a1-3d343a181c3b","order_by":1,"name":"Shirong Li","email":"","orcid":"","institution":"Wuhu Hospital Affiliated to East China Normal University","correspondingAuthor":false,"prefix":"","firstName":"Shirong","middleName":"","lastName":"Li","suffix":""},{"id":451622504,"identity":"59f8a1d7-a077-4290-9d8d-85fae6bf3d6c","order_by":2,"name":"Niuniu Sun","email":"","orcid":"","institution":"Henan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Niuniu","middleName":"","lastName":"Sun","suffix":""},{"id":451622505,"identity":"b9825ba3-7641-403d-899b-cc050e5dbc2a","order_by":3,"name":"Yuqian Deng","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Yuqian","middleName":"","lastName":"Deng","suffix":""},{"id":451622506,"identity":"a392c8fb-68eb-4723-9b58-2123fe80ad7e","order_by":4,"name":"zhenjie Yu","email":"","orcid":"","institution":"Tianjin Medical 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University","correspondingAuthor":true,"prefix":"","firstName":"Yibo","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-02-04 14:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5959047/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5959047/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13690-025-01815-w","type":"published","date":"2026-02-27T15:57:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82326904,"identity":"f0abcfaf-acf9-4be4-b3e4-64fedaf9aac7","added_by":"auto","created_at":"2025-05-09 06:25:23","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":440172,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFig 3 \u003c/strong\u003eAssociation between the adverse childhood experiences (ACEs) subgroup and family health: adjusted β and 95% CIs for general linear models\u003c/p\u003e\n\u003cp\u003eβ: standardized coefficient, CI: confidence interval\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5959047/v1/888ff201ab8d877509e7c21b.jpeg"},{"id":103765812,"identity":"25d2d4dc-0d61-4752-83e6-ad37858564ef","added_by":"auto","created_at":"2026-03-02 16:09:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2146760,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5959047/v1/9221bb84-e475-4d82-be87-3a6d8f7e90d5.pdf"},{"id":82326144,"identity":"438dcdb6-29d7-46dc-b570-b0908fe49343","added_by":"auto","created_at":"2025-05-09 06:17:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":298601,"visible":true,"origin":"","legend":"","description":"","filename":"figureandtablesupplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-5959047/v1/46888786d56a7f8e768dbc88.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations Between Adverse Childhood Experiences and Family Health in Adulthood: A National Cross-Sectional Analysis","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eFor the first time, gender differences in family health outcomes associated with Adverse Childhood Experiences (ACEs) were quantified in a Chinese population, filling a regional research gap.\u003c/li\u003e\n \u003cli\u003eStrong associations between three key ACEs subtypes (a history of incarceration, sexual abuse, and family mental illness) and intergenerational family dysfunction.\u003c/li\u003e\n \u003cli\u003eWeak buffering effect of socioeconomic status in adulthood on the intergenerational transmission of affect in ACEs.\u003c/li\u003e\n \u003cli\u003eCulturally adapted screening mechanisms for ACEs and gender-differentiated family intervention programs in Chinese public health policy.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eAdverse Childhood Experiences (ACEs) represent a prevalent global issue rooted in dysfunctional early childhood environments. Among 546,458 adult participants, approximately six out of ten reported at least one ACE, including abuse, domestic violence, caregiver mental illness, and substance abuse. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Cumulative ACE exposure significantly increases the risk of chronic diseases, cardiovascular issues, cancer, and depression, while decreasing well-being, prosocial behavior, and family intimacy. ACEs also correlate with harmful behaviors like alcohol abuse, smoking, and sleep disorders. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe family, as a confluence of biological, legal, and emotional connections, transmits its health status intergenerationally and is influenced by the health of the family of origin and the dynamics of extended kinship. Family health is a holistic concept encompassing the physical, social, emotional, economic, and medical well-being of all its members. It goes beyond individual characteristics or economic indicators, focusing on factors like social/emotional support, healthy lifestyle adoption, economic stability, and access to healthcare.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e High levels of family health management can significantly mitigate psychological and behavioral issues. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In China, deeply rooted familial values facilitate the transmission and sharing of healthy behaviors, awareness, and capabilities among family members. The COVID-19 pandemic highlighted this dynamic, as the exchange of information strengthened family health, bolstering resilience and promoting overall well-being. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Life Course Health Development (LCHD) model integrates life course, biomedical, and biopsychosocial perspectives to explore the complexity and non-linear nature of individual health trajectories. It highlights how these trajectories are influenced by environment, time, and social structures, \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e particularly during childhood, adolescence, and early adulthood. \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003eACEs within the family can disrupt a child's developmental trajectory, increasing health risks in adulthood. Research indicates that children from families with positive communication are at lower risk of ACEs. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Family development is a lifelong process involving changes across multiple life stages, including marital relationships, parenting roles, employment, and responsibilities like caring for aging parents or coping with chronic diseases. As children transition into adulthood, their roles and responsibilities evolve, and the family of origin acts as the \"health leader,\" shaping and transmitting various family responsibilities. Individuals who have experienced ACEs may develop a \"pattern of pronounced disadvantage,\" \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e with adversities complicating the family environment, leading to poor communication, escalating disagreements, and hostile conflicts. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Conversely, the LCHD model also suggests that health development is adaptive, promoting resilience and plasticity despite adverse environments. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Not all individuals who experience ACEs respond negatively; some may seek improvement, maintaining hope and optimism. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePrevious research has highlighted the importance of early life conditions in shaping life course outcomes, particularly during the first two decades of life, when socioeconomic health inequalities significantly impact adult health. \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Both ACEs and negative childhood socioeconomic conditions are associated with poor life course outcomes. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e However, some studies suggest that the relationship between ACEs and health outcomes does not show significant differences across socioeconomic status (SES) groups. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Despite this, the role of SES in adulthood, particularly whether higher SES can mitigate the negative effects of ACEs on family health, remains unclear. According to the LCHD model, SES in adulthood may moderate the cumulative effects of ACEs and shape family health trajectories. Further research is needed to clarify how higher SES may buffer the impact of ACEs on family health.\u003c/p\u003e \u003cp\u003eCurrent research on the impact of ACEs on family health is relatively scarce. Previous studies indicate gender differences in the impact of ACEs on psychological and behavioral health, with varying results across populations and cultural contexts. \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e This study uses nationally representative data to analyze the impact of ACEs on family health in adulthood, stratified by gender and examining regional differences. Additionally, we will explore the mediating effect of SES in adulthood on the relationship between ACEs and family health and assess whether sociodemographic factors modify this relationship.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData and study participants\u003c/h2\u003e \u003cp\u003eData for this study were sourced from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey conducted from June 20 to August 31, 2023, using a multistage probability sampling strategy. \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003eParticipants were randomly selected from 34 provinces/regions of mainland China (excluding Taiwan) and the Hong Kong and Macau Special Administrative Regions, covering 150 cities, 202 districts/counties, 390 townships/streets, and 800 communities. Quota sampling, based on the 2021 Seventh National Population Census, ensured the sample reflected gender and age distributions of the population. Inclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;18 years, Chinese nationality, residing in China (\u0026le;\u0026thinsp;1 month/year outside), ability to complete the online questionnaire independently or with assistance, and comprehension of the questionnaire items. Exclusion criteria included individuals with cognitive impairments, psychiatric disorders, or participation in similar studies, as well as those unwilling to participate. The adjusted sample size was 30,054, with a final sample of 30,048 after excluding 6 questionnaires of unknown origin. Trained interviewers distributed questionnaires to participants via an online survey platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), obtained informed consent from each participant, and recorded the questionnaire IDs assigned to them, ensuring privacy and confidentiality.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFamily Health\u003c/h3\u003e\n\u003cp\u003eThis study was based on the Family Health Scale-Short Form (FHS-SF) established by scholar Alice Ann Crandall,\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e modified and adjusted to fit the context and cultural characteristics of China. The revised FHS-SF includes four dimensions and ten items: \"Family Social/Emotional Health\" (α\u0026thinsp;=\u0026thinsp;0.88), \"Healthy Family Lifestyle\" (α\u0026thinsp;=\u0026thinsp;0.84), \"Family Health Resources\" (α\u0026thinsp;=\u0026thinsp;0.75), and \"External Family Social Support\" (α\u0026thinsp;=\u0026thinsp;0.75). All questions were answered using a 5-point Likert scale, ranging from \"strongly disagree\" to \"strongly agree\" (scored 1 to 5). The negatively worded items under \"Family Health Resources\" were reverse scored (\"strongly agree\" = 1), resulting in a total score range of 10 to 50, with higher scores indicating better family health. The FHS-SF demonstrated good reliability and validity (α\u0026thinsp;=\u0026thinsp;0.81).\u003c/p\u003e\n\u003ch3\u003eAdverse Childhood Experiences\u003c/h3\u003e\n\u003cp\u003eIn this study, we used the ACEs scale from the Behavioral Risk Factor Surveillance System (BRFSS) to assess whether participants experienced seven types of adversity before the age of 18: physical abuse, emotional abuse, sexual abuse, household mental illness, substance abuse, domestic violence, and having a family member with a history of incarceration. Each type of adversity was dichotomized (0\u0026thinsp;=\u0026thinsp;not experienced, 1\u0026thinsp;=\u0026thinsp;experienced), and the scores were summed to generate a total ACE score ranging from 0 to 7, with higher scores indicating greater exposure to adversity. For further analysis, we categorized the total ACE score into five groups: 0, 1, 2, 3, and 4 or more.\u003c/p\u003e\n\u003ch3\u003eSocioeconomic status in adulthood\u003c/h3\u003e\n\u003cp\u003eSES in adulthood was classified using the Li's Chinese Urban Residents Scale, which measures the quantity of social resources an individual can access or control.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e This scale includes eight levels of monthly household income, six levels of educational attainment, and six levels of occupational status. These items were aggregated into a cumulative SES score ranging from 3 to 20, with higher scores indicating higher SES. The scores were categorized into three levels based on quartiles: low SES (\u0026le;\u0026thinsp;9), middle SES (10\u0026ndash;12), and high SES (\u0026ge;\u0026thinsp;13), as shown in Supplementary Table S1.\u003c/p\u003e\n\u003ch3\u003eSociodemographic variables\u003c/h3\u003e\n\u003cp\u003eThe questionnaire collected data on the following variables: age (18\u0026ndash;44, 45\u0026ndash;64, 65\u0026thinsp;+\u0026thinsp;years), sex (male, female), ethnicity (Han, minorities), religious beliefs (no, yes), marital status (unmarried, married, divorced/widowed), social health insurance (no, yes), family type (including Nuclear/main/joint, couple's, single-parent, split-generation, and other forms), and diagnosed chronic conditions (0, 1, 2 or more). Considering the regional disparities in socioeconomic development in China,\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e residents of more developed areas and urban settings likely possess higher health capital.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e We also collected information on the respondents' residence (rural or urban) and region (eastern developed, central developing, western underdeveloped). Health behaviors were assessed, including alcohol drinking (no, yes) and smoking (no, yes).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eChi-square tests and rank-sum tests were used to compare demographic characteristics stratified by gender. To identify potential confounders, we reviewed relevant literature and conducted univariate analyses, then created a Directed Acyclic Graph (DAG) to illustrate the main relationships between independent variables, dependent variables, covariates, and mediating variables (Supplementary Fig S1). After identifying the confounders, we separately applied generalized linear regression to estimate the standardized coefficients (β) and 95% confidence intervals (CI) for the associations between the number and types of ACEs and family health. Two models were established: Model 1 was unadjusted, while Model 2 adjusted for age, gender, ethnicity, marital status, religious beliefs, social health insurance, family type, diagnosed chronic conditions, residence, region, and health behaviors (alcohol consumption, smoking). To further explore potential mechanisms, we used the Bootstrap method to test whether SES in adulthood mediated the relationship between ACEs and family health. To address intergroup differences, overlap weighting propensity score (OWPS) matching was employed to compare the associations between participants with and without ACEs and family health. Propensity scores were calculated based on the aforementioned confounders, and generalized linear models were re-applied to ensure the robustness of the results. All statistical analyses were performed using R statistical software (version 4.3.1), with a two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study has passed the ethical review of Shandong Provincial Hospital (SWYX: NO.2023\u0026thinsp;\u0026minus;\u0026thinsp;198) and has been registered as a study in China Clinical Trial Registry (ChiCTR2300072573). All respondents volunteered to participate and were informed of the details of the study prior to the survey. Written informed consent was obtained from all respondents and they were assured of confidentiality.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline characteristics of the 30,048 study participants from the 2023 PBICR. The sample comprised 15,038 female and 15,010 male. On average, the family health score was 39.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25 for male and 40.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02 for female. The prevalence of each ACE type ranged from 4.2% (family member with a history of incarceration) to 23.8% (emotional neglect). Male exhibited higher prevalence rates for specific ACE types, such as physical abuse, household substance abuse, and family member incarceration history, compared to female. Regarding the cumulative number of ACEs, 11.3% of participants experienced exactly one ACE, while 4.0% experienced four or more ACEs.\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\u003eBasic Characteristics of Participants by Gender, PBICR, 2023\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=\"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\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;30 048)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;15 010)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;15 038)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\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\u003eAge (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 687(55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 339(55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 343(55.4)\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 \u003cp\u003e46\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 344(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 651(31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 693(31.2)\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\u0026ge;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 022(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 020(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 002(13.4)\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 \u003cp\u003e\u003cb\u003eEthnicity (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 295(90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 653(91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 642(90.7)\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 \u003cp\u003eMinorities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 753(9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 357(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 396(9.3)\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 \u003cp\u003e\u003cb\u003eMarital 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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 897(29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 731(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 166(27.7)\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 \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 9424(64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 537(63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 887(65.8)\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 \u003cp\u003eDivorced/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 727(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e742(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e985(6.5)\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 \u003cp\u003e\u003cb\u003efamily type (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuclear/main/ joint family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 431(74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 062(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 369(75.6)\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 \u003cp\u003eCouple's family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 965(16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 638 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 327(15.5)\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 \u003cp\u003eSingle-parent family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 087(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e499(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e588(3.9)\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\u003eSplit-generation family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93(0.6)\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 \u003cp\u003eOther families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 392(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e731(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e661(4.4)\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 \u003cp\u003e\u003cb\u003eDiagnosed chronic conditions (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 455(68.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 017(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 438(68.1)\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 811(19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 993(19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 818(18.7)\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 \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 782(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 000(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 782(11.8)\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 \u003cp\u003e\u003cb\u003eSocial health insurance (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 440(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e739(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e701(4.7)\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 \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 608(95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 271(95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 337(95.3)\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 \u003cp\u003e\u003cb\u003eReligious beliefs (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 760(92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 951(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 809(91.8)\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 \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 288(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 059(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 229(8.2)\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\u003eIndividual health behavior\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\u003e\u003cb\u003eAlcohol drinking (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 227(64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 089(47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 138(80.7)\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 \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 821(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 921(52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 900(19.3)\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 \u003cp\u003e\u003cb\u003eSmoking (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 877(79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 554(63.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 323(95.2)\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\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 171(20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 456(36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e715(4.8)\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 \u003cp\u003e\u003cb\u003eRegion (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEastern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 793(39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 982(39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 811(38.6)\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 \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 587(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 188(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 399(22.6)\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 \u003cp\u003eWestern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 668(38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 840(38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 828(38.8)\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 \u003cp\u003e\u003cb\u003eResidency (%)\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 318(31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 650(31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 668(31.0)\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 \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 730(69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 360(69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 370(69.0)\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 \u003cp\u003e\u003cb\u003eSocioeconomic 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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh SES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 273(34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 541(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 732(38.2)\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\u003eMedium SES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 381(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 397(35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 984(33.1)\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\u003eLow SES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 394(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 072(33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 322(28.7)\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 \u003cp\u003e\u003cb\u003eDependent variables (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.86\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\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\u003eIndependent variables (%)\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\u003e\u003cb\u003ePrevalence 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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 243(74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 059(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 184(74.4)\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 \u003cp\u003e1 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 394(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 625(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 769(11.8)\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 \u003cp\u003e2 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 975(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 067(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e908(6.0)\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 \u003cp\u003e3 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 239(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e620(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e619(4.1)\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\u003e4 or more ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 197(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e639(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e558(3.7)\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 \u003cp\u003e\u003cb\u003eSpecific 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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 038(23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 181(24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 857(22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 319(25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 133(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 186(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenderual abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 650(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e795(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e855(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold substance misuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 112(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 175(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e937(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 446(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e731(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e715(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold domestic violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 664(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 381(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 283(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncarcerated household member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e713(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e412(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e301(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eContinuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE. Categorical variables were presented as n (%). ACEs: adverse childhood experiences.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003e Kruskal-Wallis test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the relationship between the number and types of ACEs and family health, categorized by gender. In the crude model, there was a clear negative association between the number of ACEs and family health, using those with no ACEs as a reference. For male, experiencing one ACE did not significantly affect family health. In the adjusted Model 2, controlling for demographics, all types of ACEs were significantly linked to poorer family health outcomes. Specifically, male showed pronounced negative associations with family health from having a family member with a history of incarceration (β = -4.51, 95% CI: -5.11 to -3.91, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), sexual abuse (β = -4.09, 95% CI: -4.53 to -3.65, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and household mental illness (β = -3.95, 95% CI: -4.41 to -3.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, female exhibited significant negative associations with family health from family member incarceration (β = -3.18, 95% CI: -3.86 to -2.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), household mental illness (β = -2.70, 95% CI: -3.15 to -2.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sexual abuse (β = -2.39, 95% CI: -2.80 to -1.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Both genders also showed weaker but significant associations between emotional abuse (males: β = -1.89, 95% CI: -2.17 to -1.61, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; females: β = -1.74, 95% CI: -2.01 to -1.48, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and physical abuse (males: β = -1.98, 95% CI: -2.26 to -1.70, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; females: β = -2.23, 95% CI: -2.52 to -1.94, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) with family health.\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\u003eAssociation between adverse childhood experiences (ACEs) and family health.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\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\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModel 2\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel 1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModel 2\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence of ACEs\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 \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.28(-0.59,0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.23(-0.54,0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.54(-0.83, -0.24)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-0.36(-0.65, -0.07)\u003c/b\u003e \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-1.38(-1.76, -1.00)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.18(-1.55, -0.80)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-1.45(-1.85, -1.06)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.16(-1.55, -0.77)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-1.56(-2.05, -1.07)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.31(-1.80, -0.83)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-2.25(-2.72, -1.77)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.74(-2.20, -1.27)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 or more ACEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-6.91(-7.40, -6.43)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-5.89(-6.38, -5.39)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-6.51(-7.01, -6.02)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-5.10(-5.61, -4.59)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\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\u003eSpecific ACE\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-2.46(-2.74, -2.18)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.98(-2.26, -1.70)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-2.93(-3.21, -2.64)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.23(-2.52, -1.94)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-2.33(-2.62, -2.05)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-1.89(-2.17, -1.61)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-2.28(-2.55, -2.01)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.74(-2.01, -1.48)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenderual abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-4.95(-5.39, -4.51)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-4.09(-4.53, -3.65)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-3.15(-3.56, -2.73)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.39(-2.80, -1.98)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold substance misuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-3.38(-3.75, -3.01)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-2.27(-3.03, -2.29)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-3.50(-3.89, -3.10)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.30(-2.70, -1.91)\u003c/b\u003e\u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-3.78(-4.22, -3.33)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-3.95(-4.41, -3.49\u003c/b\u003e\u003csup\u003e\u003cb\u003e) ****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-4.80(-5.26, -4.35)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.70(-3.15, -2.25)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold domestic violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-3.21(-3.55, -2.87)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-2.68(-3.02, -2.34)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-3.28(-3.62, -2.94)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.27(-2.62, -1.93)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncarcerated household member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-4.80(-5.49, -4.12)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-4.51(-5.11, -3.91)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-5.69(-6.29, -5.08)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-3.18(-3.86, -2.51)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eβ: standardized coefficient, CI: confidence interval, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, ****p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, statistically significant in bold.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ea Model 1 was the crude model.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eb Model 2 was adjusted for age, gender, ethnicity, marital status, age, gender, marital status, family type, diagnosed chronic conditions, social health insurance, religious beliefs, alcohol drinking, smoking, residency, region.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ec Reference: No ACEs exposure.\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 shows the relationship between the cumulative number of ACEs and subdimensions of family health. In the adjusted Model 2, both male and female who experienced four or more ACEs had significant negative associations with family social/emotional support (males: β = -2.65, 95% CI: -2.84 to -2.46; females: β = -2.53, 95% CI: -2.73 to -2.34, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). However, among participants who experienced four or more ACEs, the association with family health resources was negative but not statistically significant.\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\u003eAssociation of No. of adverse childhood experiences (ACEs) with sub-dimensions of family health\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\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=\"\u0026minus;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c12\" namest=\"c2\"\u003e \u003cp\u003eβ (95% CI) by No. of ACEs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\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\u003eModel 1\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\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 \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;social and\u003c/p\u003e \u003cp\u003eemotional\u0026nbsp;health\u0026nbsp;processes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.25(0.37,0.13)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.70(-0.84, -0.55)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.92(-1.10, -0.73)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-3.02(-3.20, -2.84)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.48(-0.59, -0.37)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.92(-1.07, -0.77)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-1.15(-1.33, -0.97)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-3.09(-3.28, -2.90)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;healthy lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.10(0.18,0.02)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.27(-0.37, -0.17) ***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.46(-0.58, -0.33)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.93(-2.06, -1.81)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.22(-0.29, -0.14)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.40(-0.50, -0.30)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.56(-0.68, -0.44)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-1.80(-1.93, -1.67)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;health\u0026nbsp;resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.20(0.03,0.37)\u003c/b\u003e \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.22(-0.42, -0.01) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e0.06(-0.20,0.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-0.43(-0.69,0.17) ***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.24(0.09,0.39)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e0.09(-0.12,0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.29(-0.54, -0.05)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-0.41(-0.66, -0.15)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;external social supports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.13(0.21,0.04)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.19(-0.30, -0.09)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.24(-0.38, -0.11)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.53(-1.67, -1.40)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.08(-0.16,0.002)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.22(-0.33, -0.11)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.24(-0.37,0.11)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-1.22(-1.35, -1.09)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\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\u003eModel 2\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\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 \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;social\u003c/p\u003e \u003cp\u003eand emotional\u0026nbsp;health\u0026nbsp;processes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.23(0.35,0.12)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.61(-0.76, -0.47)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.80(-0.99, -0.62)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-2.65(-2.84, -2.46)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.39(-0.50, -0.28)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.78(-0.92, -0.63)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.94(-1.11, -0.76)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-2.53(-2.73, -2.34)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;healthy lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.10(-0.18, -0.02)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.24(-0.34, -0.14)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.40(-0.53, -0.28)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.70(-1.83, -1.57)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.18(-0.25, -0.11)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.34(-0.44, -0.24)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.46(-0.58, -0.34)\u003c/b\u003e \u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-1.45(-1.59, -1.32)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;health\u0026nbsp;resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.20(0.04,0.37)\u003c/b\u003e \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e-0.22(-0.43, -0.02) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e0.003(-0.43,0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e-0.24(-0.50,0.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.20(0.05,0.35)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e0.04(-0.16,0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e-0.32(-0.57, -0.08)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e-0.27(-0.54,0.003)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u0026nbsp;external social supports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.12(0.21,0.04)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.16(-0.26, -0.05)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.16(-0.29, -0.03)\u003c/b\u003e \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-1.26(-1.39, -1.13)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.05(-0.13,0.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.16(-0.27, -0.06)\u003c/b\u003e \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c11\"\u003e \u003cp\u003e-0.12(-0.25,0.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e-0.86(-1.00, -0.72)\u003c/b\u003e \u003csup\u003e\u003cb\u003e****\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eβ: standardized coefficient, CI: confidence interval, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, ****p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, statistically significant in bold.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003ea Model 1 was the crude model.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eb Model 2 was adjusted for age, gender, ethnicity, marital status, age, gender, marital status, family type, diagnosed chronic conditions, social health insurance, religious beliefs, alcohol drinking, smoking, residency, region.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003ec Reference: No ACEs exposure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter adjusting for demographic characteristics, the mediating effect of adulthood SES on the ACEs-family health relationship was modest. The coefficient for the effect of ACEs on adulthood SES was \u0026minus;\u0026thinsp;0.08 (Supplementary Fig S2), while the coefficient for the effect of adulthood SES on family health was 0.26. Approximately 2.15% of the impact of ACEs on family health was mediated through adulthood SES (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe cumulative number of ACEs was negatively associated with family health across all regions. Urban residents generally reported higher average family health scores than rural residents (Supplementary Fig S3a). For ACE\u0026thinsp;\u0026ge;\u0026thinsp;4, scores were 32.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81 in rural areas and 34.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.13 in urban areas. While both urban and rural populations showed negative correlations between the number of ACEs and family health, no significant association was observed for 1\u0026ndash;2 ACEs among rural residents (Supplementary Table S2). Regionally, participants from the eastern region without ACE exposure had the highest family health scores (40.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83). However, with an increasing number of ACEs, particularly\u0026thinsp;\u0026ge;\u0026thinsp;4, family health scores in the eastern region were lower than in the central and western regions (32.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.11 vs. 33.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17 and 34.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27, respectively; Supplementary Fig S3b). A stepwise negative association was observed between the number of ACEs and family health across regions (Eastern: β = -6.51, 95% CI: -7.09 to -5.93; Central: β = -5.05, 95% CI: -5.90 to -4.19; Western: β = -5.30, 95% CI: -5.83 to -4.76, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with no significant association for one ACE in the western region.\u003c/p\u003e \u003cp\u003eIn this study, 7,805 participants (26.0%) experienced ACEs, with an equal gender distribution. The adjusted model revealed significant associations between social characteristics and family health among individuals exposed to ACEs. Specifically, family health was poorer among males aged 18\u0026ndash;45 (β = -0.55, 95% CI: -1.04 to -0.07, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), those who were divorced or widowed (β = -1.06, 95% CI: -1.94 to -0.18, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and individuals living in intergenerational households (β = -2.43, 95% CI: -4.31 to -0.55, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, participants with low SES (males: β = -0.93, 95% CI: -1.37 to -0.49; females: β = -1.48, 95% CI: -1.92 to -1.05, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), those living in couple families (males: β = -2.01, 95% CI: -2.54 to -1.49; females: β = -1.11, 95% CI: -1.69 to -0.53, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), or other family types (males: β = -1.79, 95% CI: -2.57, -1.01; females: β = -1.51, 95% CI: -2.23 to -0.72, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) reported significantly lower family health. Conversely, individuals with high SES reported better family health (males: β\u0026thinsp;=\u0026thinsp;1.29, 95% CI: 0.97 to 1.61; females: β\u0026thinsp;=\u0026thinsp;1.59, 95% CI: 1.13 to 2.06, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eWeights were calculated for participants with and without ACEs using the Overlap Weighting (OW) method, which reflects the probability of being assigned to the opposite group.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e The distribution of propensity scores for ACEs before and after adjustment is shown in Supplementary Fig S4. Among individuals with similar social characteristics and SES, ACEs are significantly negatively associated with family health across all subdimensions except for family health resources (Supplementary Table S3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe family environment is complex and dynamic, influenced by evolving factors and historical risks that accumulate over time, impacting its stability. Our sensitivity analysis reaffirmed key findings: exposure to ACEs correlates negatively with family health in adulthood. We observed a significant dose-response relationship between the number of ACEs and family health, though family health resources showed no such association. Moreover, the impact of ACEs on family health varied across different regions. Particularly notable was the heightened negative impact of ACEs on family health among individuals in couple or other family types, those with low SES, and those managing multiple chronic conditions. This national study offers a fresh perspective on understanding how ACEs affect family health.\u003c/p\u003e \u003cp\u003eDespite ACEs types in our study having prevalence rates similar to global estimates, overall incidence was relatively low.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Differences in sample selection and measurement methods across studies limit comparability between countries. Furthermore, social and cultural differences may influence reporting behavior, such as Confucian values emphasizing interpersonal harmony, may lead Chinese participants to underreport adversities to avoid stigma.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e High rates of physical and emotional abuse found in our study align with patterns observed in other East Asian countries,\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e possibly influenced by the \"tiger parenting\" style emphasizing discipline for academic success and family honor. \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Boys in patriarchal traditions may face stricter discipline due to higher expectations. \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eExisting research consistently indicates that ACEs are associated with poorer family health outcomes in adulthood. \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e These include experiences such as family member incarceration, sexual abuse, and family mental illness, which disrupt internal family attachment relationships and hinder individuals' ability to form deep emotional connections, especially in intimate relationships. These experiences often carry stigma, leading to social exclusion and discrimination, further weakening emotional bonds within the family. \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e From a family health perspective, ACEs show the strongest negative correlation with social and emotional support. Epigenetic studies have demonstrated that ACEs can influence gene expression through chemical modifications that accelerate cellular aging, particularly affecting brain development during early childhood. \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Such changes can have lasting effects on brain structures, impacting executive function, attention, cognition, memory, and emotional integration abilities. Psychologically, individuals who have experienced ACEs often develop coping strategies that may limit their ability to seek diverse and effective mechanisms for managing family health issues.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Research indicates persistent low levels of mental health among adults with a history of ACEs, affecting prosocial behaviors and relationships, including difficulties in forming close bonds and a preference for solitude. \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Contrary to previous findings, \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e this study did not find a significant association between ACEs and family health resources. This may be due to China's universal basic healthcare system, which ensures timely treatment and fosters trust in healthcare providers, thus providing essential health resources for families. Additionally, this study confirmed the protective role of high SES in adulthood on family health and highlighted its significant yet modest mediating effect in the relationship between (ACEs and family health. These findings suggest that interventions aimed at improving SES in adulthood may partially mitigate the detrimental impact of ACEs on family health. However, the relatively small proportion of the mediating effect may be attributed to the lower prevalence of ACEs among individuals with high SES and the pronounced direct impact of ACEs on family health. This underscores the importance of family-centered intervention strategies, particularly those addressing psychological distress and complex dynamics within the family environment. Future interventions should integrate family-level factors and processes more comprehensively to effectively prevent or alleviate the negative effects of ACEs on family health in adulthood and to meet the diverse needs of vulnerable family systems.\u003c/p\u003e \u003cp\u003eResidents who have experienced ACEs in different social environments exhibit disparities in family health. ACEs are more prevalent in economically underdeveloped areas, \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e impacting residents differently based on regional health resources. Compared to economically developed and urban areas in China, western and rural regions face uneven public resource allocation, \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e potentially leading to weaker health awareness and higher poverty levels, affecting family regulation and health management. \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e However, ACEs in rural areas don't necessarily compromise family health, these environments may support stable family development through shared family dinners, supportive communities, and lower life stress. \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn subgroup analyses, ACEs within married or nuclear family types may influence conflict management in intimate relationships, potentially leading to avoidance, aggression, or silent treatment that impacts family dynamics or parent-child relationships. (Amone-P'Olak, 2022) ACEs survivors facing low SES in adulthood and multiple chronic diseases endure environmental pressures hindering their ability to care for family members, challenging family functioning.\u003c/p\u003e \u003cp\u003eACEs survivors with similar social characteristics exhibit gender differences in family health. Men tend to experience higher allostatic load in response to chronic stressors, leading to greater psychological distress and compromised quality of life.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e Aging may equip individuals with coping strategies to manage life stressors, potentially improving family health outcomes over time.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Therefore, it is plausible to further explain that older ACEs survivors may exhibit better family health due to the accumulation of long-term life experiences and coping strategies.\u003c/p\u003e \u003cp\u003eThis study has several limitations. Firstly, although our sample is representative of China, it does not include individuals aged 17 and below, limiting the generalizability and applicability of the study results. Secondly, collecting data on experiences before the age of 18 retrospectively may introduce recall bias. But previous studies have reported that self-reported ACEs remain reasonably reliable over time.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Lastly, this study employs a cross-sectional design, which cannot establish causality between ACEs and family health. Future research may utilize longitudinal data to delve deeper into the association between ACEs and family health.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study, based on a nationally representative adult population, reveals a significant dose-response relationship between ACEs and family health in adulthood, except for family health resources. Utilizing the LCHD model, we gained deeper insights into the long-term impacts of early ACEs on family health, which are intertwined with individual characteristics and social environments. Factors such as marriage, family type, chronic conditions, and SES in adulthood significantly modify this relationship. The high adaptability of family health highlights the critical importance of preventing ACEs and integrating interventions at the individual, family, and community levels. This aligns with global action plans advocated by various national sectors in response to the WHO's global action plan, emphasizing the promotion of health and well-being among family members.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Shandong Provincial Hospital (Approval No. SWYX: 2023-198) and registered with the China Clinical Trial Registry (Registration No. ChiCTR2300072573). Written informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo protect participant confidentiality, the raw dataset contains identifiable information and is therefore not publicly available. De-identified data supporting the findings can be requested from the corresponding author (Yibo Wu, [email protected]) following approval from the Shandong Provincial Hospital Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYN and SL contributed equally to this work. YN conceptualized the study, curated data, conducted formal analyses, and drafted the original manuscript. SL developed the methodology, performed validation procedures, and created visualizations. NS conducted investigations and managed research resources. YD implemented software solutions and performed data validation. ZY oversaw project administration. LZ provided supervisory guidance. YW contributed to study conceptualization and critically revised and edited the manuscript. All authors reviewed and approved the final submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to all participants in the\u003cem\u003e\u0026nbsp;Psychology and Behavior Investigation of Chinese Residents\u003c/em\u003e project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYang Ni1#, Shirong Li2#, \u0026nbsp;Niuniu Sun3, \u0026nbsp; Yuqian Deng4, Zhenjie Yu5, Lei Zha6, \u0026nbsp; Yibo Wu7*\u003c/p\u003e\n\u003cp\u003e1 Department of Gynecology and Obstetrics, Wuhu Conch Hospital - Anhui, China\u003c/p\u003e\n\u003cp\u003e2 Department of Respiratory Medicine, Wuhu Hospital Affiliated to East China Normal University - Anhui, China\u003c/p\u003e\n\u003cp\u003e3 School of Nursing, Henan University of Science and Technology - Henan, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4 Xiangya School of Nursing, Central South University \u0026ndash; Hunan, China\u003c/p\u003e\n\u003cp\u003e5 School of Nursing, Tianjin Medical University - TianJin, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6 Respiratory Medicine Care Unit, Yijishan Hospital of Wannan Medical College - Anhui, China\u003c/p\u003e\n\u003cp\u003e7 School of Public Health, Peking University - Beijing, China\u003c/p\u003e\n\u003cp\u003e# Yang Ni and Shirong Li are co-first authors, and they contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e*Corresponding author name and email address: Yibo Wu - [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMadigan S, Deneault AA, Racine N, et al. 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J Psychiatr Res Oct. 2018;105:9\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychires.2018.08.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychires.2018.08.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5959047/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5959047/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e Whether Adverse childhood experiences (ACEs) influence family health relationships in adulthood remains an understudied area. The aim of this study was to assess the relationship between ACEs and family health and the mediating effect of socioeconomic status (SES) in adulthood.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethod\u003c/b\u003e The 2023 PBICR was a national survey of 30,048 Chinese residents aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years. We measured ACEs with the 7-item ACEs Questionnaire and family health with the Family Health Simplified Scale. Generalized linear models were used to explore the relationship between the number and type of ACEs with family health. The mediating effect of socioeconomic status (SES) in adulthood on the relationship between ACEs and family health was further examined.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResult\u003c/b\u003e The most common type of ACEs in our study was emotional neglect (23.8%). All types of ACEs were negatively associated with family health. Of these, a history of incarceration (male: β= -4.51 (95% CI:-5.11 to -3.91; female: β= -3.18 (95% CI:-3.86 to -2.51), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), sexual abuse (male: β= -4.09 (95% CI:-4.53 to -3.65); female: (β= -2. 39, 95% CI:-2.80 to -1.98), P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and family mental illness (male: β= -3.95 (95% CI:-4.41 to -3.49); female: (β= -2.70, 95% CI:-3.15 to -2.25), P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were more significantly negatively associated with family health. However, there was a dose response between ACEs and family health in addition to family health resources. In addition, mediation analyses showed that the mediation proportion of SES in adulthood was only 2.15%, and ACEs participants with different residential, regional, and social characteristics had different family health performance.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e The remote impact of early ACEs on family health suggests the need to integrate multidimensional interventions to reduce the long-term risk of childhood trauma and promote the health and well-being of family members.\u003c/p\u003e \u003cp\u003eContributions to the literature\u003c/p\u003e \u003cp\u003e\u0026bull; For the first time, gender differences in family health outcomes associated with Adverse Childhood Experiences (ACEs) were quantified in a Chinese population, filling a regional research gap.\u003c/p\u003e","manuscriptTitle":"Associations Between Adverse Childhood Experiences and Family Health in Adulthood: A National Cross-Sectional Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 06:17:18","doi":"10.21203/rs.3.rs-5959047/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-06T07:05:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-05T05:47:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290258180058431166315487830056343531670","date":"2025-08-30T01:09:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T09:18:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264601001451080739007040156094614759844","date":"2025-07-28T02:03:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-01T03:08:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-19T10:56:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T10:53:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2025-02-04T14:38:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd3cb818-6aa2-4982-b273-1c097c18af57","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:06:18+00:00","versionOfRecord":{"articleIdentity":"rs-5959047","link":"https://doi.org/10.1186/s13690-025-01815-w","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2026-02-27 15:57:49","publishedOnDateReadable":"February 27th, 2026"},"versionCreatedAt":"2025-05-09 06:17:18","video":"","vorDoi":"10.1186/s13690-025-01815-w","vorDoiUrl":"https://doi.org/10.1186/s13690-025-01815-w","workflowStages":[]},"version":"v1","identity":"rs-5959047","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5959047","identity":"rs-5959047","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}