Adverse Childhood Experiences and Healthcare Utilization in Children of Foreign-Born Parents

Background and Purpose: Adverse Childhood Experiences (ACEs) have been linked to increased healthcare utilization and higher unmet medical needs for children in limited-resource households. These early life stressors can contribute to long-term health challenges and financial strain on families. Children of foreign-born parents may face additional barriers in accessing adequate care, further compounding the effects of ACEs. Therefore, this study aims to assess the relationship between ACEs and healthcare utilization, focusing on children with foreign-born parents in the U.S.

Methods: Data were obtained from the 2022 National Survey of Children's Health (n=7,773; children aged 0–17). Healthcare utilization was assessed by asking parents to determine if a child received mental health services or specialized medical visits (yes/no). Independent variables were cumulative ACEs capturing nine experiences: financial hardship, parental divorce/separation, parental incarceration, parental death, witnessing domestic violence, being a victim of neighborhood violence, living with an adult suffering from mental illness or substance use, and experiencing discrimination (yes/no). The nine binary responses were summed to create a measure indicating whether a child experienced: 0 ACE, 1 ACE, or 2+ ACEs. Cross-tabulations obtained prevalence estimates. Two logistic regression models assessed associations between independent and dependent variables, while controlling for sex, age, race/ethnicity, health status, insurance type, household language, family structure, parental education, parental employment, and poverty level. Data analysis utilized SPSS vs. 29 (p < 0.05).

Results: Out of 7733 children, 17.2% (n=1,329) were reported by their parents to have utilized healthcare. Children with two or more ACEs (33.2%) and those with at least one ACE (22%) were associated with higher prevalence of healthcare utilization compared to those without ACEs (14.7%). In the unadjusted logistic regression model, children who experienced two ACEs (aOR=1.64, 95%CI=1.41–1.90) and one ACE (aOR=2.88, 95%CI=2.37–3.50) were significantly associated with lower odds of healthcare utilization compared to those without ACEs. Similarly, children exposed to one ACE (aOR=1.78, 95%CI=1.50–2.11) and two or more ACEs (aOR=2.08, 95%CI=1.50–2.11) were more likely to utilize healthcare compared to those without ACE exposure in the adjusted logistic regression model.

Conclusion: This study underscores the need for interventions to address barriers and unmet needs in healthcare utilization for children from immigrant households. Implementing programs such as early identification of trauma-informed care and increasing access to affordable health insurance could alleviate the long-term health effects and financial burdens associated with ACEs. Tailored policies and culturally sensitive healthcare models may enhance access and improve outcomes for children impacted by ACEs from resource-limited immigrant households in the U.S.