Associations Between Adverse Childhood Experiences and Physical Activity, Recreational Screen Time, and Sleep Among U.S. Children

Adverse childhood experiences (ACEs) are a public health concern in the United States. Using the 2019 National Survey of Children's Health, this cross-sectional secondary analysis examined associations between cumulative ACEs (0, 1, 2, and 3 or more) and three health behaviors among children ages 6 to 17, including physical activity, recreational screen time, and sleep. Interaction models were also estimated by child sex and race/ethnicity (White non-Hispanic, Black non-Hispanic, and Hispanic) to assess whether these associations differed across groups. Nearly half of children experienced at least one ACE, and about one in eight experienced three or more. In adjusted models, higher numbers of ACEs were associated with a lower likelihood of meeting recreational screen time guidelines and sleep recommendations, while no statistically significant association was observed for meeting physical activity recommendations. Interaction analyses by child sex and race/ethnicity found no statistically significant differences in these associations across groups. These findings suggest that children with higher numbers of ACEs may be less likely to meet recommended sleep and recreational screen time guidelines, underscoring the potential value of trauma-informed strategies that strengthen sleep routines and healthy media practices.