Author ORCID Identifier
Semester
Spring
Date of Graduation
2026
Document Type
Dissertation
Degree Type
PhD
College
Eberly College of Arts and Sciences
Department
Psychology
Committee Chair
Nicholas Turiano
Committee Member
Bridget Bailey
Committee Member
Ryan Best
Committee Member
Kathleen Morrison
Abstract
Exposure to adverse childhood experiences (ACEs) has been consistently linked to suboptimal health outcomes and behaviors across the lifespan. As such, there has been widespread adoption of measures like the 10-item cumulative ACEs count measure developed by Felitti and colleagues (1998) across research literature and clinical practice. However, this measure was not developed with consideration of optimal psychometric properties and thus consists of several limitations that inhibit understanding of the specific dimensions of adversity that influence health outcomes. This 3-study dissertation focused on different measurement and statistical techniques to better understand the associations between ACEs and health. In study 1, Midlife Development in the United States (MIDUS) data were utilized to conduct an extensive factor analysis to quantify how different types of ACEs group together and whether these specific ACEs factors predicted all-cause mortality hazard. Results revealed that the factor of abuse anyone outside of the immediate family were associated with elevated mortality hazard. In Study 2, twin and sibling data from MIDUS were utilized to calculate discrepant ACEs reporting within families. Reporting a higher ACEs score relative to family members was associated with elevated quantity of alcohol consumption and higher odds of illicit drug use. In Study 3, data on ACEs scores, perceptions of the negative impact of ACEs in adulthood, and substance use were collected from a representative United States sample. ACEs scores, but not participants’ perceptions of negativity, predicted elevated engagement in substance use. Overall, each operationalization of ACEs provided evidence for specific dimensions of adversity that differentially contribute to suboptimal health behaviors and outcomes. These findings should encourage researchers and clinicians to be intentional in statistically modeling and selecting measures of ACEs depending on the question they are trying to answer.
Recommended Citation
Miller, Sarah Josephine, "Operationalizations of Adverse Childhood Experiences and Health Prediction" (2026). Graduate Theses, Dissertations, and Problem Reports. 13277.
https://researchrepository.wvu.edu/etd/13277