Do Adverse Childhood Experiences Include Racial Discrimination? a Scoping Review

Background and Purpose: Research on the impact of Adverse Childhood Experiences (ACEs) has significantly grown over the last 20 years. The ACE literature describes the cumulative and deleterious impact of childhood adversity. Simultaneously, a body of work has explored the impact of racism and racial discrimination on health and well-being. Yet, there is little work that focuses on the combined impact of ACE and racial discrimination. Some suggest that the ACE construct should extend to include additional adversities, like community violence, bullying, and racial discrimination. To understand the current use of racial discrimination as an ACE indicator this study aimed to answer the following research question: To what extent do studies of ACEs incorporate racial or ethnic discrimination in their conceptualization of adversity?

Method: For the scoping review, a comprehensive protocol was utilized to conduct standardized search of the literature. Inclusion criteria consisted of peer-reviewed English-language journal articles available between 2017–2018 of US based samples, intervention and observational studies that included an ACE index. Data were extracted by two independent raters about the ACE index used, population studied, type of data collected, and outcomes measured.

Results: A total of 294 studies were included for full-text review. Out of these articles 23 (7.82%) included racial discrimination as an indicator and 271 (92.18%) did not. The vast majority of studies that did use racial discrimination as an indicator used the same data set, the National Survey of Children’s Health (NSCH). The NSCH includes the question “unfair treatment because of race/ethnicity “ as an ACE indicator beginning in 2010/2011 data set. Because the majority of studies in the scoping review were based on the NSCH, most of the outcomes were focused on child health and mental health conditions. Unfortunately, even when racial discrimination was included as an indicator the implications of this experience was not often discussed. Two papers provided notable examples of how to include the experience of racism into ACE index. Of the papers that did not include racial discrimination as an ACE indicator, although most identified racial differences in the cumulative count of ACEs, less than 5% even acknowledged the potential individual and structural implications of racism contributing to disparities in rates of ACE exposure.

Conclusions and Implications: Overall, this scoping review identified a void in the literature regarding the intersection of ACE and racial discrimination. As ACEs occur in the context of racism and structural inequality, it is imperative these constructs are meaningfully included into research on health. This presentation will include recommendations for incorporating racial discrimination experiences into ACE research.