Журнал исследований и разработок в области медицинского образования

Investigating the Impact of Race and Income on Adverse Childhood Experiences and Family Planning

Abstract

Mykaila Shannon

Adverse childhood experiences impact a large portion of the population in the United States [1]. Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood, between birth and 17 years of age [2]. As identified by the Centers for Disease Control and Prevention (CDC)-Kaiser study, there are 10 ACEs split into three groups [3]. The first group is abuse including physical, emotional, and sexual abuse. The second is neglect, both physical and emotional. The last is household dysfunction which includes the mother being treated violently, divorce, incarcerated relative, substance abuse, and mental illness. These experiences are characterized by aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. According to the CDC, about 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs. Traumatic experiences in childhood have lifelong consequences. Studies show that ACEs have the potential to disrupt early brain development and increase the risk of a range of physical and mental health disorders [4]. Results of a 2017 study, “Unpacking the impact of adverse childhood experiences on adult mental health,” indicate an increased likelihood of experiencing drug use, moderate to heavy drinking, suicide attempts, and depressed affect in adulthood with increased experiences of ACEs [5]. ACEs have also been linked to an increase in healthcare utilization and spending. Studies have found that high ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood [6].

Furthermore, there are potential disparities in the distribution of ACEs. According to the CDC, women and several racial/ethnic minority groups were at greater risk for having experienced 4 or more types of ACEs. Studies have shown that women are significantly more likely than males to report a range of ACEs and mental health, social, and emotional difficulties in adulthood, showing that males and females potentially have distinct patterns of childhood adversities, with females experiencing more complex and varied patterns of childhood adversity [7]. In contrast, some research has found that men and women are just as likely to experience ACEs, but women are more likely to experience some types compared to others. Girls are more likely to experience sexual abuse and to be affected by parental psychiatric problems [8]. However, boys are more likely to report childhood verbal abuse, parental divorce, parental unemployment, and parental death [9]. Some studies even suggest that there is no gender difference between childhood sexual abuse and long-term physical health [10]. It has also been reported that racial minorities are more likely to experience ACEs. Research shows that black and Hispanic children were exposed to more adversities compared with white children, and income disparities in exposure were larger than racial/ethnic disparities, suggesting that the reason for this gap in exposure is societal as well as interpersonal [11]. These findings are synonymous with the majority of the findings found in other research, and, while the data remains controversial, the majority of research finds that racial minorities are more likely to experience ACEs than non-minorities.