ACEs: Population Analysis of Life Course Trends, Health Outcomes, and Intergenerational Implications

Background/Purpose: Although epidemiological research has shown that adverse childhood experiences (ACEs) increase risk of morbidity and mortality, few studies have accessed chains of life course risk or distinguished implications of differing trajectories of stress for later well-being. Our research builds on cumulative adversity models (Ferraro&Shippee,2009), arguing for the importance of assessing individuals' social and econonic contexts (Zielinski,2009) along with health statuses. Our focus on adult respondents with minor children captures actively parenting households and, thus, the opportunity to integrate individual and intergenerational considerations of early adversity as the root of cascading disparities (Shonkoff etal,2012). We posit mechanisms of intergenerational ACEs transmission, examining differing adversity trajectories that constitute their children's ACEs and jeopardize healthy developmental contexts.

Methods: Data were collected from a population-based state survey of household adults (n=3676) through the CDC Behavioral Risk Factor Surveillance System. The random sample was stratified to represent regional levels of gender, income, education, and race/ethnicity levels. Five summed categories of respondents' adverse experiences before age 18 (eg, violence, family substance abuse) matached with comparable assessments in respondents' adulthood were used to create a four group typology of ACEs trajectories from childhood to adulthood: 1) Consistently Low, 2) Lessening, 3) Increasing, and 4) Sustained High. Seven domains of health and functionig (Financial Stain, Disability, Health Behaviors, Social Support, Physical Health, Mental Health, Care Access) were assessed, clustering multiple measures in each domain. We conducted MANOVAs for each of the domains, followed by individual ANVOAs on domain scales and post-hoc tests for specific group-to-group comparisons. Combined effects of income and social support in moderating the relationshiop of respondents' ACEs on risk of greater adult adversities were tested through logistic regression. We hypothesized significant stepped regressions across domains (groups #1-4 demonstaing incrementally poorer health and functioning), with concentrated risk of high adult adversities among low income, low support respondents.

Results: MANOVA tests for each of the 7 domains achieved signficance (p<.01), documenting omnibus negative trends across domain measures associated with increasing and greater cumulative adversities. ANOVA tests for virtually each measure within the domains achieved signficance. Between-group contrasts were also significant, reflecting anticipated incremental effects across Low to Increasing to Sustained High ACEs-trajectory groups. Moderation tests achieved signficance. Collective results demonstrated intensified risk compromising respondents' children's well-being as a function of the adversities their parents experienxed, disparities in parents' health and functioning, and paucity of economic and social family resources.

Conclusion/Implications: This study extends assessment of ACEs on life course well-being by distinguishing and testing for differential outcons as a function of cumulative adversity exposure, by accounting for presence/absence of potential buffering resources, and by testing for evidence of impaired parental health and functioning--which constitutes the developmental context within which their children are raised. In the discussion, we elaborate the theoretical basis for interpreting findings relative to biobehavioral models of stress as well as social determinant factors that foster stress proliferation and erosion of coping and resilience capacities. Implications for intergenerational transmission of risk as well as health-fostering interventions are addressed.