Methods: A confirmatory factor analysis (CFA) was conducted using a random sub-sample (n=4,000) of the 2011 - 2012 National Survey of Children’s Health (NSCH), a nationally representative, cross-sectional study of children 0 and 17 years. Eleven variables and three latent factors were used to test a CFA measurement model. The variables of interest included the predictor variable, EH, and the mediating variable, maternal wellbeing (measured by self-reported mental and physical health status). The outcome latent variable was cumulative ACE exposure, consisting of eight ACE indicators, including exposure to: parental divorce/separation, death, incarceration, domestic violence (DV), mental illness, and substance abuse (SA); neighborhood violence; and discrimination. The mediation was tested using a bootstrapping approach of 10,000 bootstrap samples.
Results: Results revealed EH and poor maternal wellbeing had significant direct effects on a child’s increased ACE exposure (R=-.205, p=<.001; R=.332, p<.001, respectively). Frequent familial EH significantly predicted poor maternal wellbeing (R=-.198, p<.001). Increased EH had a significant indirect effect on cumulative ACE exposure via poor maternal mental health (R=-0.062 p<.001). Another key finding was that caregiver SA and DV were the two strongest predictors of increased childhood ACE exposure (respectively, λ=.637, λ=.602, p<.001).
Conclusions/Implications: These results reveal that children living in households with more economic instability are also more likely to have maternal caregivers with worse mental and physical health status and are significantly more likely to have higher ACE exposures. A key finding of this study was that poor maternal wellbeing had a stronger influence on ACE exposures than the direct effect of exposure to household EH. Providing evidence that a child’s caregiver has a greater influence on exposure to adversities than environmental conditions, such as EH, and that family intervention efforts should be targeted towards promoting caregiver-child attachment. These findings demonstrate that caregivers and children are reciprocally impacted by frequent EH. Additionally, poor maternal wellbeing mediated the relationship between EH and cumulative ACE exposure. The results emphasize that children who are exposed to multiple ACEs are often exposed to other, compounding adversities such as familial EH and poor maternal wellbeing. Adding to the field, the results support the complex transactional and potentiating relationships between an individual and their environments. Identification of protective and risk factors across domains will help researchers identify the most vulnerable populations.