NYMC Student Theses and Dissertations

Date of Award

5-28-2025

Document Type

Doctoral Dissertation - Open Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Kenneth A. Knapp

Second Advisor

Erin D. Bouldin

Third Advisor

Nkemdilim C. Chukwueme

Abstract

The chronic impact of early-life experiences on long-term health is a critical area of investigation, especially regarding cognitive health in adulthood. Adverse childhood experiences (ACEs) have been linked to an increased risk of developing various health issues in adulthood, including mental health disorders, substance abuse, and chronic diseases. The connection between ACEs, substance abuse and cognitive health, particularly subjective cognitive decline (SCD), remains relatively underexplored. The aim of this study is to examine the intricate relationships between ACEs, alcohol abuse, and SCD in adulthood. This study draws on trauma theory and the biopsychosocial model to conceptualize the long-term impact of childhood adversity on cognitive functioning and alcohol dependence in adulthood. This is a retrospective, cross-sectional study that includes 41,687 U.S. adults aged 45 years and above from the BRFSS dataset from 2020 to 2023 who responded to the ACE and SCD modules. The primary variables were ACEs exposure and adult alcohol abuse. The outcome variable was SCD in adulthood. Covariates included demographic and socioeconomic factors such as age, sex, race/ethnicity, education level, and employment status. A survey-weighted chi-square test was used for bivariate analysis, and survey-weighted logistic regression models were employed to assess the effect of ACEs and adult alcohol abuse on SCD, controlling for each covariate. ACEs and adult alcohol abuse were each strongly associated with SCD in adulthood (High ACEs = aOR: 3.43, 95% CI: 2.95–3.98, p < 0.001; Low ACEs = aOR: 1.69, 95% CI: 1.49–1.91, p < 0.001; adult alcohol abuse = aOR: 1.22, 95% CI: 1.04–1.42, p = 0.013). Their interaction did not show a statistically significant combined effect on SCD (p = 0.414). Employment status and education level had a protective role in iideveloping SCD in adulthood among the participants. The public health impact of childhood adversity is evident in the very strong association between childhood adversity and cognitive decline. Any type of childhood adverse events and all forms of substance abuse have a negative impact on cognition, be it at an older age or a younger age.

Keywords: adverse childhood experiences, adult alcohol abuse, subjective cognitive decline, BRFSS.

Disciplines

Medicine and Health Sciences | Psychiatry and Psychology | Public Health

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