Positive Childhood Experiences and Adult Health and Opportunity Outcomes in 4 US States.
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IMPORTANCE: Safe, stable, and nurturing childhood relationships and environments promote optimal child development. It is less understood how these experiences measurably affect individuals' lifelong health and well-being into adulthood. OBJECTIVE: To assess health and life opportunities and economic value associated with positive childhood experiences (PCEs) reported by adults. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Behavioral Risk Factor Surveillance Survey data from adults (≥18 years) from 4 states (Kansas [2020], Montana [2019], South Carolina [2020], and Wisconsin [2015]), analyzed from May 2023 to April 2024. EXPOSURE: Seven PCEs (adult made you feel safe and protected, felt you belonged in high school, felt supported by friends, at least 2 adults that took an interest in you, felt your family stood by you, enjoyed community traditions, and felt able to talk to your family). MAIN OUTCOMES AND MEASURES: Primary outcomes were PCE prevalence by count (1-2, 3-5, or 6-7 PCEs), adjusted prevalence ratios (aPRs) representing the association of PCEs with adult outcomes, and the estimated economic value of PCE-associated, averted morbidity and mortality for chronic health conditions and risk behaviors. Regression models of adult cohorts by PCE exposure and matched by demographic characteristics were used to assess associations of PCEs with current life opportunities (postsecondary education and income), health risk behaviors (moderate to heavy drinking and smoking), chronic health conditions (arthritis, asthma, cancer, chronic obstructive pulmonary disease [COPD], depression, diabetes, heart disease, kidney disease, overweight or obesity, and stroke), and overall physical and mental health. Prevented fractions for the population were used to calculate the reduced proportion of total disease-specific medical spending and healthy life-years savings associated with PCEs. RESULTS: The sample size was 20 916 individuals (11 357 female [54.3%]; 4469 aged 55-64 years [21.4%]). Approximately one-half of adults (53.1%; 95% CI, 52.1-54.1) reported a high PCE score. A higher PCE score was associated with increased likelihood of attaining postsecondary education (1-2 PCEs: aPR, 1.23; 95% CI, 1.04-1.06; 3-5 PCEs: aPR 1.44; 95% CI, 1.23-1.67; 6-7 PCEs: aPR, 1.64; 95% CI, 1.42) and greater annual household income (1-2 PCEs: aPR, 1.33; 95% CI, 1.05-1.69; 3-5 PCEs: aPR, 1.74; 95% CI, 1.40-2.16; 6-7 PCEs: aPR, 2.17; 95% CI, 1.75-2.68), and lower likelihood of smoking (3-5 PCEs: aPR, 0.79; 95% CI, 0.70-0.89; 6-7 PCEs: aPR, 0.64; 95% CI, 0.57-0.72). Higher PCE scores were also associated with lower prevalence of most chronic conditions (any condition for those with 3-5 PCEs: aPR, 0.88; 95% CI, 0.83-0.93; any condition for those with 6-7 PCEs: aPR, 0.78; 95% CI, 0.74-0.83) including arthritis, asthma, cancer, COPD, depression, diabetes, heart disease, overweight or obesity, and poor general physical or mental health compared with having no PCEs. The estimated annual economic value of PCE-associated, reduced chronic disease in the 4 analyzed states was $215.9 billion ($3.1 billion in lower medical spending cost and $212.8 billion in additional healthy life-years) for respondents with PCE scores of 3 or more, which corresponded to an estimated $28 132 per adult per year, or $782 000 over their lifetimes. CONCLUSIONS AND RELEVANCE: This cross-sectional study quantified the importance of PCEs for lifelong health and well-being. The economic benefits associated with PCEs support consideration of strategies to promote these childhood experiences.