Adverse Childhood Experiences and Adult Health Behaviors and Outcomes: Variation By Race and Income

Background/Purpose:  Past research indicates that adverse childhood experiences (ACEs) are associated with negative health outcomes in adulthood. ACEs include childhood experiences of abuse as well as exposure to potentially harmful persons or situations, such as parental substance abuse or domestic violence. This study seeks to expand this area of research in two ways: (1) replicating ACE associations with health indicators from previous research, as well as with new indicators of health and (2) exploring how race and income moderate associations between number of ACEs and health behavior and outcomes.

Methods:  This study uses data from the 2011 Wisconsin Behavioral Risk Factor Survey (BRFS), a telephone-based survey of adults conducted by the Wisconsin Department of Human Services and the U.S. Center for Disease Control and Prevention. We use linear regression models to estimate associations between the number of ACEs respondents report and their health behaviors and outcomes by race and income, adjusting for respondents’ demographic characteristics. Over 4,000 respondents provided information about ACEs, with 44% reporting none, 25% reporting 1 or 2, 19% reporting between 3 and 5, and 12% reporting 6 or more ACEs.

Results:  Descriptively, adults who report the highest rates of ACEs are also more disadvantaged than groups reporting none or fewer ACEs– they have lower income, less education, are more likely to be divorced and less likely to be married than their counterparts who report no or few ACEs. They also are younger and more likely to be female, have children, identify as a sexual minority, have a disability, and to be unemployed.  Regression results suggest that the number of reported ACEs is significantly associated with increased negative health behaviors (e.g. binge drinking, tobacco use, lack of exercise) and negative health outcomes (e.g. obesity, depression, poor overall health). Moderation analyses suggest that associations between ACEs and health vary by race and income. Number of ACEs is more strongly associated with increased negative health outcomes and behaviors among black respondents than whites. ACEs are also more strongly associated with negative health behaviors among higher income respondents than lower income respondents. Additionally, results indicate that the threshold at which ACEs influence negative health outcomes may be higher among lower income respondents than higher income respondents. That is, lower income respondents do not experience significantly worse mental health, worse overall health, or increased rates of depression unless they report six or more ACEs, whereas the threshold for higher income respondents is one or more ACEs.

Conclusion:  Overall, this study indicates that the influence of ACEs on adult health outcomes may differ across race and income groups. Specifically, white and lower income adults who report ACEs may experience fewer negative health behaviors and outcomes than black and higher income adults who report ACEs.  Adulthood income also moderate these associations differently for white and black respondents.  Implications of these findings for health disparities are discussed.