Development of the THL Adverse Childhood Experiences Questionnaire (ACE THL)
Research objectives
The aim of the research project is to design a short questionnaire on adverse childhood experiences (ACEs) that describes the phenomenon comprehensively, with unambiguous items and appropriate response options.
The THL Adverse Childhood Experiences Questionnaire (ACE-THL) is developed for the Healthy Finland Survey. The ACE-THL Questionnaire is intended to be suitable for both the general population and more targeted samples (such as in psychiatric care and social work). The questionnaire will also be used in the Turvapolku (“Path to Safety”) research study for shelter clients.
Background of the research
Since the 1990s, accumulating research evidence (e.g., Felitti et al. 1998) has deepened our understanding of the long-lasting and cumulative negative effects of childhood adversities. The most cited ACEs in studies have included various forms of violence against the child, neglect, and multiple family problems (witnessing inter-parental violence, mental health and substance abuse problems in the family, imprisonment and other separation from the parent, for example, due to divorce). Previous research consistently shows that these ACEs are associated with increased health risks and other problems later in life.
According to a large systematic review, having four or more ACEs compared to having no ACEs doubles the risk of obesity and diabetes, triples the risk of smoking, cancer, heart, or respiratory disease. Furthermore, the risk of sexual risk behaviour, mental health problems, and alcohol problems is four times higher, and the risk of problematic drug use as well as violent and self-destructive behaviour is approximately seven times higher after four or more ACEs compared to none (Hughes et al. 2017).
Prospective studies have shown that the above-mentioned health harms are not only explained by the health-damaging risk behaviours that follow ACEs, such as substance abuse and smoking, but also by other processes. Several complementary theoretical explanations have been proposed, the best known of which are related to toxic stress and epigenetic modulation (Miller et al. 2011; Shonkoff & Garner 2012).
Consistent research evidence on the role of ACEs for an individual's psychological, social, and physical well-being has led many public services and service developers internationally to pay increasing attention to the prevention of these experiences. In addition, several countries regularly collect population-level data on the prevalence of ACEs to inform policymaking and intervention design. In Finland, no such large-scale data collection has so far been carried out to investigate the prevalence of ACEs.
Implementation
The questionnaire design study was carried out in two phases. In the first stage, adults were interviewed, and they completed the preliminary questionnaire on childhood experiences. The interviewer then filled in the same questionnaire without knowing the respondent's answers. In addition, the respondent was asked about the comprehensibility of the questions.
Data gained from the interviews were used to adapt the questionnaire and improve item clarity. In the second stage, the ACE-THL was completed by a larger group of respondents, who were also asked to complete the same questionnaire two weeks later. The repeated survey data were used to assess the test-retest reliability and structural validity of the questionnaire.
The interviews and the survey were conducted by Taloustutkimus Oy. The survey data were analysed by THL.
Using the ACE-THL questionnaire
The ACE-THL Questionnaire is freely available for use by referring to the psychometric validation article (Hietamäki, Laajasalo, Lindgren & Therman, 2023). ACE-THL is currently available in Finnish, Swedish, and English. Please see the page Translations of the ACE-THL for further information. For inquiries regarding the translation of the ACE-THL questionnaire please contact Sebastian Therman ([email protected]). The questionnaire is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.
Attribution 4.0 International (CC BY 4.0) (creativecommons.org)
Copies of any publications using the ACE-THL should be sent to the email address ace-thl(at)thl.fi to be added to the reference list for the method.
Funding
THL
Further information
Johanna Hietamäki
Senior Researcher
tel. +358 29 524 7990
E-mail: [email protected]
Sebastian Therman
Senior Researcher
tel.: +358 29 524 8925
E-mail: [email protected]
