State Legislators' Opinions About Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions.

Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p<.001). Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.