What Protects Children with Adverse Childhood Experiences from Having Poor Health Outcomes?

Background: While previous research has widely evidenced that adverse childhood experiences (ACEs) are associated with child health outcomes, most of these studies have primarily focused on examining risk factors that lead to poor health outcomes. Relatively little research has investigated protective factors that mitigate the impacts of ACEs on poor health outcomes. Drawing on the socio-ecological framework, which considers the dynamic interplay of multi-level factors influencing health, the current study aimed to identify multi-level protective factors that significantly play a role in the association between ACEs and perceived health status.

Methods: The current study used cross-sectional data from the 2020-2021 National Survey of Children’s Health, which is a nationally representative sample survey of children’s health conducted by the U.S. Census Bureau. Caregivers of children aged under 18 years completed the survey. Data were weighted to represent all noninstitutionalized children in the US. ACEs were measured by asking caregivers to indicate whether the child had experienced ACEs (e.g., parental divorce, parental incarceration, parental death, etc.). The multi-level protective factors include parenting competence, family resilience, neighborhood cohesion, and health insurance coverage. Caregivers were also asked to rate the child’s health status (i.e., poor, good, very good/excellent). Multinomial logistic regression model was used to explore the associations between ACEs and child’s overall health status perceived by caregivers. In particular, the study examined which multi-level protective factors are significantly related to the child’s health status. Covariates include child characteristics and household demographics.

Results: Results of multinomial logistic regression analysis showed that the model fit was good, F (40, 88887) = 27.71, p<.001. The reference group was caregivers who rated their children’s overall health as excellent or very good. For every one-unit increase in the number of ACEs, caregivers were 21% more likely to rate their child’s overall health as fair/poor and were 11% more likely to rate their child’s health as good. Having higher levels of parenting competence was associated with significant decreases in the risk of having fair/poor (RRR=.53, p<.001) and good (RRR=.61, p<.001) health status among children. Similarly, caregivers who perceived higher levels of neighborhood cohesion were less likely to rate their child’s health as fair/poor (RRR=.83, p<.001) and good (RRR=.90, p<.001). Interestingly, there was no significant relationship between health insurance coverage and health status. Regarding demographic characteristics, caregivers of African American children were more likely to report their children had fair/poor (RRR=1.63, p<.001) and good (RRR=1.39, p<.001) health status.

Conclusions and Implications: Caregivers of children having a greater number of ACEs were more likely to rate their child’s health as fair/poor or good, corroborating prior research. Notably, given that higher levels of perceived parenting competence and neighborhood cohesion were associated with significant decreases in the risk of fair/poor and good health, it is critical to provide caregivers with parenting interventions aimed at improving parenting competence. In addition, it is also important to develop more community-based programs that promote social cohesion. Importantly, more research that informs the development and implementation of public health policies should be conducted to enhance macro-level protective factors.