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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Karen A. Kalmakis

Second Advisor

Genevieve E. Chandler

Third Advisor

Ryan S. Wells

Subject Categories

Family Practice Nursing | Maternal, Child Health and Neonatal Nursing | Nursing | Public Health | Public Health and Community Nursing


Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings.

Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship.

Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program in Saudi Arabia. A total of 6,356 participants were obtained from the original sample, all of them were Saudi adults aged 18 years or older. The data analyses included: descriptive statistics, t-test, chi-square, and logistic regression.

Results: The results of the analyses revealed high rates of ACEs in Saudi Arabia as 87.7% of participants reported at least one ACE, and 49.2% reported 4 or more ACEs. There was a statistically significant geographical difference of ACEs between urban and non-urban settings, with higher mean ACEs score for those who lived in urban settings. The results also showed that 37.6% of the total participants had at least one of the included chronic diseases. There was no statistically significant difference in chronic disease prevalence between urban and non-urban settings. However, there was a statistically significant relationship between ACEs and chronic diseases in Saudi Arabia. This relationship was moderated by geographical setting, with greater association among those who reported ACEs and lived in urban settings.

Conclusions: This study revealed important results about ACEs prevalence in Saudi Arabia, and relationship between ACEs and chronic diseases, as well as the moderating effect of geography. The results provided insights about ACEs that may help in evaluating, refining, and developing strategies for healthcare in Saudi Arabia. Knowledge of these results can inform healthcare policymakers in the country about the importance of ACEs effect on health. Specific interventions and initiatives are required to track, regularly screen for, and prevent ACEs in Saudi Arabia, with a focus on underserved populations.