Date of Award

Spring 2019

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Rachel E. Davis


This study considered Adverse Childhood Experiences (ACEs) to be an underlying cause of engagement in risk behaviors and that the implementation of protective factors, or positive relationships and environments, can reduce long-term implications of ACEs. First, this study examined the empirical relationship between safe, stable, and nurturing relationships (SSNRs), exposure to ACEs, and risk behaviors using a population-level health survey in South Carolina. The results of this research, which demonstrate that SSNRs moderate the relationship between ACEs and risk behaviors, provide innovative evidence for the role of protective factors in reducing exposure to ACEs and risk behavior engagement. Next, this study used qualitative methodology to explore practice (child-and family-serving professionals) and policy (state policymakers) perspectives on protective factors and how they can be implemented through state-level policies and programs that address ACEs. The findings from this research provide valuable insight on the complex state-level policymaking process and resulted in several evidence-based policy and program recommendations for addressing ACEs in South Carolina. Overall, this study makes a significant and innovative contribution to the public health literature, reinforcing the importance of social determinants of health, and generating important knowledge about the extent to which protective factors may prevent ACEs and reduce engagement in risk behaviors and their associated health consequences.