Abstract
BACKGROUND: Adverse Childhood Experiences have been implicated in a range of health-related risk behaviors in adulthood, but there is limited research on how these patterns manifest among internal migrant workers in China. This study aims to elucidate the mediating role of family functioning and explore generational differences in this relationship. METHODS: A cross-sectional study was conducted among two groups of migrant workers in China: first-generation migrant workers (FGWs) and new-generation migrant workers (NGMWs). A total of 2,187 participants completed surveys that assessed adverse childhood experiences, family functioning, and health-related risk behaviors. Mediation analysis was performed to examine the indirect effects of adverse childhood experiences on health risks through family functioning. Additionally, moderated mediation analysis was conducted to explore potential differences between FGWs and NGMWs. RESULTS: Adverse childhood experiences significantly predicted higher health-related risk behaviors and lower family functioning (p < 0.001). Family Functioning mediated the relationship between adverse childhood experiences and health-related risks behaviors, which accounted for approximately 16.67% of the total effect (95% CI 0.03 to 0.07, p < 0.001). There was a significant difference in the indirect effects between NGMWs and FGWs (95% CI 0.01 to 0.06, p < 0.05). The indirect effect of adverse childhood experiences through family functioning was significant for NGMWs (p < 0.001), but non-significant for FGWs. CONCLUSION: Our study fills a critical gap in understanding the intricate links between adverse childhood experiences, family functioning, and health-related risk behaviors among China migrant workers in China. It highlights the role of family functioning as a significant mediator of the impact of early adverse childhood experiences on adult health-related risks behaviors, particularly in a vulnerable population like migrant workers. More importantly, our findings indicate that this mediation varies significantly between FGWs and NGMWs. Family functioning exhibited a stronger mediating effect between early adverse childhood experience and adult health-related risks behaviors for NGMWs compared to FGWs.