Adverse Childhood Experiences, Health and Employment: A Study of Men Seeking Job Services

Background: The link between adverse childhood experiences (ACEs), a proxy for early trauma exposure, and health has been well-established; however, most ACE studies rely on samples that are representative of the U.S. population at-large. Whether ACEs are associated with health-related outcomes among disadvantaged samples or whether ACEs influence outcomes beyond health is less well-known. This study explored the relations between ACEs, health-related impairments, and employment-related problems with a sample of low-income, minority men seeking job services Milwaukee, WI.

The purpose of the study was to test hypothesized predictors of joblessness among Black men in a city where the problem is longstanding and widespread. The individual-level predictors were selected for investigation because community partners revealed that the success of their job placement programs was often undermined by the confluence of trauma, addictions, and mental illness.

The following research questions guided analyses:

1) Are ACEs associated with behavioral and mental health outcomes?

2) Do adverse childhood experiences (ACEs), behavioral health problems and mental health symptoms predict employment-related difficulties?

3) Do adult health-related outcomes help mediate the relation between ACEs and employment-related difficulties?

Methods:  Using a cross-sectional survey design, we collected data from a convenience sample (N=199) of men accessing drop-in job services across four federally-funded, workforce development sites in Milwaukee. Study participants were recruited within a five week period and completed a 134-item survey. All participants, mean age 34, were searching for jobs, and 80.4% reported an annual income below $10,000. Less than 16% reported exposure to 0 ACEs, while nearly 40% endorsed exposure to 5 or more. In addition, the sample’s self-reported rates of cigarette smoking and substance abuse along with their average number of symptoms of depression and anxiety were notably higher than population averages, and over 50% endorsed persistent job-related problems.

To address question 1, we ran unadjusted comparisons of sample mean rates for health-related measures by ACE score. To address question 2, logistic regressions were conducted in which a dichotomous variable indicating longstanding employment-related problems was regressed on a set of predictors including age, education status, ACEs Index 0-10, cigarette smoking, substance abuse, depression and anxiety. Hierarchical regressions addressed the question of mediation.

Results: Men exposed to 5 or more ACEs had a 2 to 6 times greater chance of encountering behavioral or mental health-related problems relative to men reporting no ACE exposure The ACE index along with substance abuse, depression and anxiety significantly predicted longstanding employment-related problems. In addition, substance abuse and depression mediated the distal link between ACEs and longstanding employment-related problems, accounting for over 40% of the variance in the association.

Implications: Our results suggest that for low-income men of color, ACEs influence health and extend their influence through health to the all-important outcome of employment. Results recommend that urban-based, job placement programs consider integrating behavioral and mental health services into their menu of offerings. Programs might also address ACE exposure through trauma-focused services, a unique recommendation that recognizes the critical role early trauma can play in adult functioning particularly among low-income adults.