Associations between Adverse Childhood Experiences, Major Depressive Episode and Chronic Physical Health in Adolescents: Moderation of Race/Ethnicity

Adverse childhood experiences (ACEs) can negatively affect lifelong health and opportunity. Acquired brain injury (ABI), which includes traumatic brain injury (TBI) as well as other causes of brain injury, is a health condition that affects millions annually. The present study uses data from the 2014 North Carolina Behavioral Risk Factor Surveillance System to examine the relationship between ACEs and ABI. The study sample included 3454 participants who completed questions on both ABI and ACEs. Multivariable logistic regression models were used to determine the relationship between ACEs and ABI as well as ACEs and TBI. Sexual abuse, emotional abuse, physical abuse, household mental illness and household substance abuse were significantly associated with ABI after adjusting for age, race/ethnicity, gender and employment. Compared with those reporting no ACEs, individuals reporting three ACEs had 2.55 times the odds of having experienced an ABI; individuals reporting four or more ACEs had 3.51 times the odds of having experienced an ABI. Examining TBI separately, those who experienced sexual abuse, physical abuse, household mental illness and had incarcerated household members in childhood had greater odds of reported TBI, after adjusting for age, race/ethnicity, gender and income. Respondents reporting three ACEs (AOR=4.16, 95% CI (1.47 to 11.76)) and four or more ACEs (AOR=3.39, 95% CI (1.45 to 7.90)) had significantly greater odds of reporting TBI than respondents with zero ACEs. Prevention of early adversity may reduce the incidence of ABI; however, additional research is required to elucidate the potential pathways from ACEs to ABI, and vice versa.

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Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing

Pediatric Research ◽

10.1038/s41390-020-01188-6 ◽

2020 ◽

Author(s):

Ellen Goldstein ◽

James Topitzes ◽

Julie Miller-Cribbs ◽

Roger L. Brown

Keyword(s):

Protective Factors ◽

National Survey ◽

Adverse Childhood Experiences ◽

Family Resilience ◽

Children's Health ◽

Children’S Health ◽

Childhood Experiences ◽

Adverse Childhood ◽

Race Ethnicity ◽

Cumulative Adversity

Abstract Background The impact of early adversity increases the risk of poor outcomes across the life course. Identifying factors that protect against or contribute to deleterious life outcomes represents an important step in resilience promotion among children exposed to adversity. Informed by resilience science, we hypothesized that family resilience mediates the relationship between adverse childhood experiences (ACEs) and child flourishing, and these pathways vary by race/ethnicity and income. Methods We conducted a secondary data analysis using the 2016–17 National Survey of Children’s Health data reported by parents/guardians for 44,686 children age 6–17 years. A moderated-mediation model estimated direct, indirect, and total effects using a probit link function and stacked group approach with weighted least square parameter estimates. Results The main variables were related in expected directions. Family resilience partially mediated the ACEs-flourishing association. Although White and socioeconomically advantaged families were more likely to maintain family resilience, their children functioned more poorly at high-risk levels relative to Black and Hispanic children and across income groups. Conclusion Children suffer from cumulative adversity across race/ethnicity and income. Partial mediation of family resilience indicates that additional protective factors are needed to develop comprehensive strategies, while racial/ethnic differences underscore the importance of prevention and intervention programs that are culturally sensitive. Impact The key message of the article reinforces the notion that children suffer from cumulative adversity across race/ethnicity and income, and prevention of ACEs should be the number one charge of public policy, programs, and healthcare. This is the first study to examine family resilience in the National Survey Children’s Health (NSCH) data set as mediating ACEs-flourishing by race/ethnicity and family poverty level. Examining an ACEs dose–response effect using population-based data within the context of risk and protective factors can inform a public health response resulting in a greater impact on prevention efforts.

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