Understanding Health Equity in Early Childhood: Adverse Experiences, Socioeconomic Position, and Eating Habits

Background and Purpose: Adverse Childhood Experiences (ACEs) have been linked to detrimental long-term health outcomes. According to family stress theory, a family’s response to stressors (i.e. ACEs), influenced by their resources, can impact the coping response. Poor health behaviors have been identified as a coping response (e.g., increased consumption of calorie-dense foods). It is essential to understand how exposure to stressful events is linked to short-range familial coping that could influence health in early childhood, particularly for those of lower socioeconomic position (SEP). We hypothesize: 1) ACE exposure is associated with increased consumption of unhealthy foods (sugar-sweetened beverages [SSB], fast food, snacks), and decreased consumption of healthy foods (fruit/vegetable); 2) Those of lower-SEP, compared to higher-SEP, will have higher risk for unhealthy eating.

Methods: Data were collected from 7,000 mothers/children when children were 9 months, 2 years, and 5-years-old via observations and self-assessments in a large national sample (Early Childhood Longitudinal Study-Birth Cohort). Dependent variables include average daily intake of healthy (fruit, vegetable) and unhealthy (SSBs, snacks, and fast food) food consumption (i.e. linked to increased BMI or energy consumption) at 5-years-old. ACE exposures were included as independent variables: domestic violence (DV), substance abuse, mental/emotional distress, divorce, and incarceration. Control variables include child age, gender, urban/rural, maternal overweight, race/ethnicity, and maternal education. SEP quintiles were included as a control variable in full sample models and used to stratify sub-samples (low-SEP: Q1-2, high-SEP: Q4 -5).  Taylor series linearization was applied to regression models to examine the effect of individual and cumulative ACEs on eating behaviors in the full sample, low-SEP sample, and high-SEP sample. All results are weighted at the parent-level.

Results: On average, 37.2% of children were exposed to at least 1 adverse experience. Of these, 43.1% were exposed to mental/emotional distress, 6.6% to DV, 6.0% to divorce, 5.2% to incarceration, and 4.9% to substance abuse. On average, children consumed .64 servings of SSBs, .88 snacks, 1.43 fruits, 1.25 vegetables per day, and 28% consumed fast food at least 2/week. Full sample models: DV was associated with increased SSBs (B=.23, p=.01), sweet snacks (B=.22, p=.02), and decreased fruits (B=-.18, p=.03). Divorce was associated with decreased sweet snacks (B=-.18, p=.02); incarceration was associated with decreased fruits (B=-.25, p=.04). Stratified models: DV was associated with increased SSBs in the low SES group (B=.25, p=.048) and increased sweet snacks in the high-SEP group (B=.36, p=.04). The association between divorce and sweet snacks held within the low-SEP group only (B=-.26, p=.007). Incarceration was also associated with decreased salty snack consumption in the low-SEP group only (B=-0.42, p=.002). Mental/emotional distress, drug use, and the number of ACEs exposed to were not associated with eating behaviors.

Conclusions and Implications: Consumption of unhealthy foods was higher for those exposed to DV in the low-SEP (SSBs) and high-SEP (sweet snacks) groups. In the full sample, fruit consumption was lower for those exposed to incarceration. Social workers can uncover positive coping strategies appropriate within cultural and environmental contexts. Future research should explore effective coping alternatives that promote health.