Adverse childhood experiences and tobacco smoke exposure among U.S. school-aged children.

Background: Adverse childhood experiences (ACEs) are traumatic events linked to poor health outcomes in childhood. While children are vulnerable to ACEs and tobacco smoke exposure (TSE), little is known about the association between ACEs and home TSE. Objective: This study aimed to assess the association between ACEs and home TSE status among U.S. school-aged children. Participants and setting: A secondary analysis of the 2020-2021 National Survey of Children's Health data, including 26,422 children 6-11 years old, was conducted. Methods: ACEs were assessed cumulatively and based on type, including household-, community-, and financial-based ACEs. Home TSE status included no home TSE, defined as the child not living with smokers; home thirdhand smoke (THS) exposure only, defined as the child living with smokers who did not smoke indoors; and home secondhand smoke (SHS) and THS exposure, defined as the child living with smokers who smoked indoors. Weighted adjusted multinomial logistic regression analysis was performed. Findings: Concerning the number of ACEs, 22.4 % of children experienced one ACE, 12.2 % experienced 2-3 ACEs, and 4.9 % experienced 4-10 ACEs. Children with one ACE (AOR = 1.59, 95 %CI = [1.26, 1.99]; AOR = 2.00, 95 %CI = [1.17, 3.41]), 2-3 ACEs (AOR = 2.62, 95 %CI = [1.98, 3.45]; AOR = 4.36, 95 %CI = [2.52, 7.56]), and 4-10 ACEs (AOR = 5.16, 95 %CI = [3.48, 7.65]; AOR = 9.71, 95 %CI = [4.74, 19.88]) had increased odds of home THS exposure only and home SHS + THS exposure, respectively, compared to children with zero ACEs. Household-, community-, and financial-based ACEs increased the odds of home THS exposure only and home SHS + THS exposure. Conclusion: ACEs were associated with home TSE status in school-aged children.