Adverse Childhood Experiences (ACEs) and Military Career Choice: A Quantitative and Policy Analysis

Exploring the Relationship Between Adverse Childhood Experiences (ACEs) and Military Career Choice: A Quantitative and Policy Analysis for Public Health Interventions by Abdulrasak Opeyemi Ejiwumi Adverse Childhood Experiences (ACEs) are significant public health concerns associated with long-term physical, behavioral, and mental health outcomes. Emerging evidence suggests that individuals with a history of military service may experience higher levels of ACE exposure compared to the general population; however, limited research has examined how ACEs influence military career choice or the role of trauma-informed policies in recruitment. This dissertation aims to: 1) synthesize existing literature on ACEs, resilience, and trauma-informed practices within military contexts; 2) examine the association between ACE exposure and military service using nationally representative data; and 3) analyze military recruitment policies to identify opportunities for integrating trauma-informed approaches and provide recommendations. Aims 1 and 2 were guided by a public health framework incorporating trauma-informed practice (TIP) and an adapted Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. Aim 1 involved a scoping review of studies published between 2011 and 2024 following PRISMA-ScR guidelines. Aim 2 used cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), with weighted bivariate and multivariable logistic regression analyses. Aim 3 consisted of a policy analysis of U.S. military recruitment documents. Findings from Aim 1 indicate that while resilience and coping among military personnel with ACE exposure are well studied, limited attention has been given to ACEs in relation to military career choice and trauma-informed recruitment policies. For Aim 2, higher ACE scores were significantly associated with increased likelihood of military service, with each additional ACE increasing the odds of veteran status. Protective factors such as physical activity, adequate sleep, and access to healthcare were associated with improved mental health outcomes. For Aim 3, policies acknowledged mental health and resilience but lacked consistent integration of trauma-informed approaches in recruitment processes. This dissertation recommends integrating ACE-informed screening frameworks, such as SBIRT, into recruitment processes, alongside standardized policies and improved access to mental health resources. These strategies may enhance resilience, improve force readiness, and support long-term well-being among military personnel.