(WITHDRAWN) Exploring How Family Resiliency Moderates the Relationship between Aces and Health for Black and White Youth at Different Poverty Levels

Background: Adverse Childhood Experiences (ACEs) refer to detrimental events that may be experienced by children and are related to negative outcomes throughout their life course. Health related outcomes may include alcoholism and drug abuse, mental health disorders, suicidality, obesity, cancer, heart and lung diseases, and others. While the original set of ACEs focused on three categories (abuse, household challenges, and neglect), subsequent research has argued for the inclusion of an expanded set with environmental factors like discrimination or neighborhood safety. When a more inclusive set of ACEs are used, race and poverty are associated with a higher risk for exposure.

This study explored: 1) if family resilience moderates the relationship between ACES and child health while controlling for race, parent education, and age; and 2) if the impact on the likelihood for good health varies by poverty level.

Methods: This study used data from the 2016 National Survey of Children’s Health (NSCH). ACEs examined from the NSCH included mental illness, violent treatment of the mother, incarceration of a relative, divorce, substance abuse in the family, experience with poverty, witnessing neighborhood violence, experiencing racial discrimination, or experiencing the death of a parent. The sample size was n = 42,036, with ages ranging from zero to seventeen. The sample was 49% female and 7.32% Black or African-American.

Key variables were identified in the dataset based on the research questions, and consisted of number of ACEs, family resilience, race, age, and parent education. Relevant data was extracted from the larger dataset for analysis. A multilevel analysis was run due to the clustering by socioeconomic status.

Results: Overall results of the multilevel analysis found that having two or more ACEs resulted in a reduction in the odds of good health (β=-1.06, p < .0001), as did being Black (β=-0.39, p < .01), and getting older (β=-0.06, p < .0001). Family resilience (β=0.61, p < .001) and having a parent with an education beyond high school (β=1.08, p < .0001) each significantly predicted greater odds of good health. Family resilience moderated the interaction between ACEs and good health (β=-0.10), but was not statistically significant. This effect was more impactful for Black youth than White children. Level two of the model showed that poorer respondents were more likely to have lower odds for good health, while those making 3-4 times the Federal Poverty Level had higher odds.

Conclusions and Implications: The findings support the connection between multiple ACEs and poorer health report, and demonstrates the relationship between race, poverty, and health. It also demonstrates the connections between race, poverty, and health. While the moderation effect of family resilience was not statistically significant, the implications it has for impacting the racial health gap warrant further study. Future study should delve into this, while practitioners may find benefit in focusing on improving the resilience of families to better the odds of good health for the child.