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Item Beyond the Lines: Exploring the Impact of Adverse Childhood Experiences on NCAA Student-Athlete Health(CSRI, 2020) Brown, Braden J.; Jensen, Jakob F.; Hodgson, Jennifer L.; Schoemann, Alexander M.; Rappleyea, Damon L.; Family Medicine, School of MedicineEmerging research has highlighted a link between adverse childhood experiences (ACEs) and various health concerns experienced by NCAA student-athletes. Building on prior work (Kaier, Cromer, Davis, & Strunk, 2015), we hypothesized that ACEs would significantly predict student-athletes’ biopsychosocial (BPS) health and that spirituality would serve as a protective factor against the effect of ACEs on BPS health outcomes. Division I, II, and III NCAA student-athletes (N = 477) representing 20 sports across 53 universities completed an online quantitative survey (k = 133) that assessed for ACEs, injury/physical health concerns, anxiety, depression, stress, social support, substance use, and spirituality. Nearly two-thirds (64.5%) of student-athletes endorsed at least one ACE. Structural Equation Models (SEMs) yielded significant positive relationships between ACEs and anxiety, depression, perceived stress, injury/health problems, and substance use, and a negative relationship with social support while controlling for sex, race, school, and division. Additionally, spirituality had a significant negative effect on anxiety, depression, perceived stress, injury/health problems, and substance use, and a positive effect on social support. SEM moderation analyses indicated that spirituality only moderated the relationship between ACEs and substance use. Specifically, at average and high levels of spirituality, the relationship between ACEs and substance use was stronger. Clinical implications, study limitations, and future research directions are discussed.