Date of Conferral

4-8-2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Richard Jimenez

Abstract

Adverse childhood experiences (ACEs) have been associated with adverse health outcomes in adulthood; however, less is known about their relationship with preventive health behaviors such as cervical cancer screening. The purpose of this quantitative, correlational study was to examine associations between selected ACEs and cervical cancer screening among women aged 18–65 in South Carolina. Data were drawn from the 2020 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) and included 1,323 women. Binary logistic regression analyses were used to examine unadjusted and adjusted associations between ACE exposures and being up to date with Pap testing, controlling for age, race/ethnicity, income, and education. Most women were up to date with screening. In unadjusted analyses, all three ACE exposures—living with a problem drinker or alcoholic, living with someone who used illegal drugs, and living with a household member with mental illness—were significantly associated with Pap test utilization. In adjusted models, living with someone who used illegal drugs was associated with higher odds of screening (AOR = 1.64, 95% CI [1.58, 1.70], p < .001), while living with a problem drinker or alcoholic (AOR = 0.95, 95% CI [0.92, 0.98], p < .001) and living with a household member with mental illness (AOR = 0.71, 95% CI [0.69, 0.73], p < .001) were associated with lower odds. Results indicate that ACEs were differentially associated with cervical cancer screening, underscoring a complex relationship and the importance of trauma-informed preventive healthcare. This study has the potential to improve screening uptake and reduce health disparities through trauma-informed public health approaches.

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