Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women

Abstract

BACKGROUND:

Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups.

AIMS:

This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups.

METHODS:

A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach’s alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE’s theoretical structure and Pearson’s correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW.

RESULTS:

The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square (χ²) = 14.26, degrees of freedom (df) = 9, p = 0.113, minimum discrepancy (CMIN/df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00–0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW.

CONCLUSION:

This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.

Keywords

adverse childhood experiences sexual and gender minority sexual minority psychometric

Get full access to this article

View all access options for this article.

References

Adamson

S. J.

Kay-Lambkin

F. J.

Baker

A. L.

Lewin

T. J.

Thornton

Kelly

B. J.

Sellman

J. D.

(2010). An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence, 110(1–2), 137–143. https://doi.org/10.1016/j.drugalcdep.2010.02.017

Austin

Herrick

Proescholdbell

(2016). Adverse childhood experiences related to poor adult health among lesbian, gay, and bisexual individuals. American Journal of Public Health, 106(2), 314–320. https://doi.org/10.2105/AJPH.2015.302904

Bränström

Pachankis

J. E.

(2018). Sexual orientation disparities in the co-occurrence of substance use and psychological distress: A national population-based study (2008–2015). Social Psychiatry and Psychiatric Epidemiology, 53(4), 403–412. https://doi.org/10.1007/S00127-018-1491-4/TABLES/3

Brown

T. A.

(2015). Confirmatory factor analysis for applied research (2nd ed.). The Guilford Press.

Byrne

B. M.

(2016). Structural equation modeling with Amos: Basic concepts, applications, and programming (3rd ed.). Routledge.

Centers for Disease Control and Prevention. (2023). Fast facts: Preventing adverse childhood experience. https://www.cdc.gov/violenceprevention/aces/fastfact.html

Feil

Riedl

Böttcher

Fuchs

Kapelari

Gräßer

Toth

Lampe

(2023). Higher prevalence of adverse childhood experiences in transgender than in cisgender individuals: Results from a single-center observational study. Journal of Clinical Medicine, 12(13), 4501. https://doi.org/10.3390/JCM12134501

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Koss

M. P.

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

Hughes

Bellis

M. A.

Hardcastle

K. A.

Sethi

Butchart

Mikton

Jones

Dunne

M. P.

(2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4

10.

Human Rights Campaign. (2023). Map: Attacks on gender affirming care by state. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map

11.

Jackson

C. L.

Agénor

Johnson

D. A.

Austin

S. B.

Kawachi

(2016). Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: A cross-sectional study. BMC Public Health, 16(1), 1–11. https://doi.org/10.1186/S12889-016-3467-1/TABLES/4

12.

Kalmakis

K. A.

Chandler

G. E.

(2014). Adverse childhood experiences: Towards a clear conceptual meaning. Journal of Advanced Nursing, 70(7), 1489–1501. https://doi.org/10.1111/jan.12329

13.

Kline

R. B.

(2016). Principles and practice of structural equation modeling (4th ed.). Guilford Publications.

14.

Matsuno

Goodman

J. A.

Israel

Choi

A. Y.

Lin

Y. J.

Kary

K. G.

(2022). L or G or B or T: Matching sexual and gender minorities with subpopulation-specific interventions. Journal of Homosexuality, 69(3), 385–407. https://doi.org/10.1080/00918369.2020.1819714

15.

McCabe

S. E.

Hughes

T. L.

West

B. T.

Evans-Polce

R. J.

Veliz

P. T.

Dickinson

McCabe

V. V.

Boyd

C. J.

(2020). Sexual orientation, adverse childhood experiences, and comorbid DSM-5 substance use and mental health disorders. Journal of Clinical Psychiatry, 81(6), 20m13291. https://doi.org/10.4088/JCP.20M13291

16.

Movement Advancement Project. (2023). Equality maps: Restrictions on drag performances. https://www.lgbtmap.org/equality-maps/criminaljustice/drag_restrictions

17.

Petruccelli

Davis

Berman

(2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse and Neglect, 97, 104127. https://doi.org/10.1016/j.chiabu.2019.104127

18.

Puckett

J. A.

Aboussouan

A. B.

Ralston

A. L.

Mustanski

Newcomb

M. E.

(2023). Systems of cissexism and the daily production of stress for transgender and gender diverse people. International Journal of Transgender Health, 24(1), 113–126. https://doi.org/10.1080/26895269.2021.1937437

19.

Rariden

SmithBattle

Yoo

J. H.

Cibulka

Loman

(2021). Screening for adverse childhood experiences: Literature review and practice implications. The Journal for Nurse Practitioners, 17(1), 98–104. https://doi.org/10.1016/J.NURPRA.2020.08.002

20.

Reuben

Moffitt

T. E.

Caspi

Belsky

D. W.

Harrington

Schroeder

Hogan

Ramrakha

Poulton

Danese

(2016). Lest we forget: Comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57(10), 1103–1112. https://doi.org/10.1111/JCPP.12621

21.

Saunders

J. B.

Aasland

O. G.

Babor

T. F.

De la Fuente

J. R.

Grant

(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/J.1360-0443.1993.TB02093.X

22.

Schnarrs

P. W.

Dorri

A. A.

Yockey

R. A.

Stone

A. L.

Russell

S. T.

Rosenberger

J. G.

(2023). The Sexual and Gender Minority Adverse Childhood Experiences Scale. American Journal of Preventive Medicine, 65, 1050–1058. https://doi.org/10.1016/J.AMEPRE.2023.08.006

23.

Schnarrs

P. W.

Stone

A. L.

Bond

M. A.

Salcido

Dorri

A. A.

Nemeroff

C. B.

(2022). Development and psychometric properties of the sexual and gender minority adverse childhood experiences (SGM-ACEs): Effect on sexual and gender minority adult mental health. Child Abuse and Neglect, 127, 105570. https://doi.org/10.1016/j.chiabu.2022.105570

24.

Schnarrs

P. W.

Stone

A. L.

Salcido

Baldwin

Nemeroff

C. B.

(2019). Differences in adverse childhood experiences (ACEs) and quality of physical and mental health between transgender and cisgender sexual minorities. Journal of Psychiatric Research, 119, 1–6. https://doi.org/10.1016/j.jpsychires.2019.09.001

25.

Skinner

H. A.

(1982). The drug abuse screening test. Addictive Behaviors, 7(4), 363–371. https://doi.org/10.1016/0306-4603(82)90005-3

26.

Solberg

M. A.

Blair

L. M.

Schlegel

E. C.

Kurzer

J. A. M. J

. (2023). Health disparities among sexual and gender minorities with adverse childhood experiences: Insights from the 2021 Behavioral Risk Factor Surveillance System data. American Journal of Public Health, 113(12), 1343–1351. https://doi.org/10.2105/AJPH2023.307420

27.

Solberg

M. A.

Carr

K. D.

Peters

R. M.

(2023). Adverse childhood experiences and health outcomes among sexual and gender minorities: A systematic review. Journal of Child and Adolescent Trauma. Advance online publication. https://doi.org/10.1007/s40653-023-00576-4

28.

Tran

N. M.

Henkhaus

L. E.

Gonzales

(2022). Adverse childhood experiences and mental distress among US adults by sexual orientation. JAMA Psychiatry, 79(4), 377–379. https://doi.org/10.1001/jamapsychiatry.2022.0001

29.

Tran

N. M.

Mann

Cortez

M. G.

Harrell

Nettuno

(2023). Adverse childhood experiences (ACEs) and mental health by gender identity in the United States, 2019–2021. Preventive Medicine, 175, 107705. https://doi.org/10.1016/J.YPMED.2023.107705

30.

Warner

(1991). Introduction: Fear of a queer planet. Social Text, 29, 3–17.

31.

The Williams Institute. (2019). LGBT demographic data interactive. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#density