Men's Traditional and Expanded ACEs: Racial/Ethnic Differences in the Prevalence and Long-Term Consequences

Background and Purpose: A large body of evidence links adverse childhood experiences (ACEs) with poor health across the life course. Despite evidence that certain ACEs, such as parental incarceration and domestic violence in the household, disproportionally affect non-Hispanic Black and Hispanic/Latino populations, it is unclear whether there are racial/ethnic differences in the experience of additional ACEs or in the long-term consequences of ACEs. When examining racial/ethnic differences in ACEs, it is important to adopt a broadened definition of ACEs to include community-level adversities. This is important because community-level adversities are experienced more frequently among racial/ethnic minority and male children and adolescents. To address these gaps, we examined, in a diverse sample of men, racial/ethnic differences in the prevalence of ACEs using both a traditional (abuse, household dysfunction) and expanded (abuse, household dysfunction, and community-level adversity) definition of ACEs, and associations between ACEs, operationalized both ways, and depressive symptomology.

Methods: We used data from 402 men from the Fathers and Families (F&F) study. F&F is a new cohort of predominately non-White fathers (mean age: 37.1) of preschool-aged children residing in Michigan. First, we used logistic regression to examine whether the prevalence of ACEs (0-2 versus 3+) varied by men’s race/ethnicity. Then, we used linear regression to examine the relationship between ACEs (0-2 versus 3+) and men’s depressive symptoms (measured by the 8-item Center for Epidemiologic Studies Depression scale). Finally, an interaction between ACEs and race/ethnicity was added using the Tukey method to examine the moderating effect of race/ethnicity on this relationship. All models were first conducted with the traditional ACE index and re-estimated with the expanded ACE index.

Results: Nine percent of men were Hispanic/Latino. Non–Hispanic participants included Asian (36%), White (35%), and Black (19%) men. Unadjusted models indicated that Asian men were less likely than White men to experience 3 or more traditional ACEs (OR 0.46, 95% CI 0.21-0.94), whereas Black men were more likely than White men to experience 3 or more expanded ACEs (OR 1.96, 95% CI 1.09-3.55). However, adjusting for other sociodemographic differences between these groups attenuated these differences. Higher reports of traditional (b=1.94, p<0.001) and expanded (b=1.39, p<0.001) ACEs were associated with greater depressive symptoms overall although results from interaction models indicated that expanded ACEs were associated with greater depressive symptoms only among Black (b=2.35, p<0.01) and Asian (b=1.95, p<0.01) men. The interaction between traditional ACEs and race/ethnicity was insignificant.

Conclusion and Implications:

Conceptualizing ACEs to include forms of mezzo- and macro-level oppression revealed a disproportionate burden of ACEs in Black men and a potentially more harmful impact of ACEs on Black and Asian men. Until this comprehensive definition of ACEs is widely adopted, we will continue to hold an inaccurate understanding of the adversities Black boys and adolescents in our society face and its impact on their mental health in adulthood. In collaboration with communities, social work researchers are well-positioned to advance the use of a unified definition of expanded ACEs and culturally-responsive measurement tools that are appropriate for the Black male population. (F31HD112054)