Adverse Childhood Experiences and Early Adult Health and Well Being in a Low-Income, Minority Sample
Methods: We analyzed panel data for 1,142 minority individuals (93% African American) born in a large metropolitan area in the Midwest in 1979 or 1980. Illustrating their underprivileged background, 83% of sample members were eligible for free lunch at school entry.
ACE indicators were derived from child welfare records and survey data gathered when participants were 22-24 years old. Eight ACEs were recorded: 1) Substantiated abuse (physical or sexual); 2) Substantiated neglect; 3) Victim or witness of violence; 4) Parent substance abuse; 5) Prolonged absence of parent; 6) Divorce of parents; 7) Frequent household conflict; 8) Chronic poverty. These items were used to create an aggregate index ranging from 0 to 5 or more ACEs.
Ten indicators of health and well-being from ages 22-27 were assessed: 1) Overall health, 2) Depression, 3) Optimism, 4) Life satisfaction, 5) Substance abuse 6) Alcohol use, 7) Marijuana use, 8) Tobacco use, 9) Violence victimization, 10) Violence perpetration. Outcomes were generated from adult survey data with the exception of violence perpetration, which originated from official crime records. Controlling for individual and family characteristics, tests of association between the ACE index and continuous criteria were performed as univariate ANOVAs. Analyses of binary outcomes (Substance abuse; Violence victimization; Violence perpetration) were modeled using logistic regression.
Results: Over half of the sample was exposed to at least one ACE, and more than a quarter of subjects were exposed to multiple ACEs. Adjusting for covariates, the ACE index was significantly associated in the expected direction with all outcomes, including self-reported health (F=4.55; p<.001), depression (F=17.85; p<.001), optimism (F=6.74; p<.001), life satisfaction (F=11.58; p<.001), substance abuse (OR=1.70; p<.001), alcohol use (F=4.33; p<.01), marijuana use (F=11.88; p<.001), tobacco use (F=12.12; p<.001), violence victimization (OR=1.64; p<.001), and violence perpetration (OR=1.27; p<.01).
Similar to prior studies, a linear trend emerged from pairwise contrasts indicating that increasing ACE values were associated with poorer outcomes. There were apparent threshold effects, however, at the tails of the ACE distribution—substantial differences materialized between adults with one ACE and adults with no ACEs as well as between adults with 5 or more ACEs and adults with 4 ACEs.
Conclusions and Implications: Supporting prior research, results suggest the accretion of ACEs has a graded association with poorer health and well-being, over and above other correlated socio-demographic risks. Mental and behavioral health consequences in emerging adulthood may combine with biological effects embedded in childhood to beget disease and ill health in later life. The ACE framework provides a compelling model to guide future research, practice and policy toward disease prevention and health promotion.