Adverse Childhood Experiences and the Onset of Health Risk Factors in Middle Childhood

Background and Purpose:Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. The implications for understanding ACEs as causes of adulthood morbidity and mortality are immense, yet previous research in the area has been limited due to reliance on retrospective data and demographically homogenous samples. Furthermore, by focusing solely on childhood experiences and adult outcomes, research has yet to establish the mechanisms by which these adult health problems develop as children age. The proposed study begins to address these gaps by prospectively identifying the onset of health risk factors (e.g. cigarette smoking, alcohol use, hypersexuality, physical inactivity) that may develop into disabling diseases and premature death in adulthood. Additionally, I will extend previous observations to racially, economically, and socially diverse subgroups of the population to gain awareness of how these groups may be differentially impacted by ACEs.

Methods: This study uses quantitative data from the Fragile Families and Child Wellbeing Study to longitudinally assess the health and adverse experiences of approximately 4,900 children. Ten ACE categories to which a child was exposed to by the age 5 were investigated: childhood abuse (emotional, sexual, and physical), neglect (emotional and physical), exposure to domestic violence, parental divorce or separation, and living with mentally ill, substance abusing, or criminal household members. Bivariate analyses were used to examine the prevalence of each ACE category across race and ethnicity (e.g. Black, White, Hispanic), household income, and family structure (e.g. married or cohabitating with child’s biological father, married or cohabitating with social father, single) subgroups. I used multivariate logistic regression to examine the association between the prevalence of ACEs (1) across each sample subgroup; and (2) with the risk of experiencing health risk factors by age 9.  

Results: The majority of children in the sample (93.9%) were exposed to ≥1 ACE category; 15% were exposed to ≥4 categories. Compared to White and Hispanic children, Black children were significantly more likely to experience a higher amount of ACEs (p<.001). Children from low income families were also found to have greater ACE exposure (p<.001). Children from families in which their mother was married to or cohabitating with the child’s biological father were found to have lowest amount of ACE exposure compared to children with other family structures (p<.001). Moreover, exposure to ACEs by age 5 was found to be significantly associated with the number of health risk factors experienced by age 9 (p<.001).

Implications: The proposed study has the potential to greatly expand current knowledge on how childhood exposures to maltreatment and household dysfunction produce long-term health consequences. Findings will highlight the subgroups that are most at-risk for ACE exposure, aiding in the development of targeted prevention policy efforts. By identifying the onset and type of health risk factors that are prevalent in middle childhood, clinical practice can be improved to prevent the progression of these health risk factors to chronic, debilitating diseases in adulthood.