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Childhood adversity: A social determinant of health and inequity over the lifespan and across generations
Methods: Using age-adjusted weighted data from the Allegheny County Health Survey (N=5,442), we calculated prevalence and 95% confidence intervals. Self-reported measures were used for race, education, parental education, household income, employment and disability status, and a 6-item scale measuring ACEs (i.e., physical, sexual and emotional abuse, parental mental illness or substance abuse, and domestic violence).
Results: For Non-Hispanic Blacks (NHBs) the prevalence of childhood sexual abuse was approximately 2.5 times greater than that of non-Hispanic Whites (NHWs); (NHBs=8.2%, 95%CI: 6.2, 10.2 vs. NHWs=3.3%, 95%CI: 2.4, 4.1). NHBs also reported significantly more physical abuse and endorsed a greater total number of ACEs when compared to NHWs. Compared to those with high SES, those with low SES had 1.7 to 4.2 times higher prevalence for each of the six ACEs; these differences were statistically significant. Significant differences in ACEs by employment and disability status were also observed. For example, those “unable to work” reported a prevalence of sexual abuse 5 times larger than those reporting “employment.”
Conclusion: Exposure to adversities during early life when sensitive periods of human development occur have the potential to cause negative social, economic, and health consequences that extend over the lifespan and across generations. Policies and programs aimed at reducing cumulative adversity will likely help to prevent further social stratification of disadvantaged groups and reduce health disparities.
Learning Areas:
Chronic disease management and preventionEpidemiology
Social and behavioral sciences
Learning Objectives:
Explain, from a life course perspective, how adverse childhood event can affect adult health.
Describe racial and socioeconomic disparities in the prevalence of adverse childhood events.
Discuss options to decrease disparities in adverse childhood events.
Keyword(s): Child Health, Survey
Qualified on the content I am responsible for because: The research presented here comes from my dissertation work, for which I coordinated data collection and conducted all analyses. I direct the Office of Health Survey Research at the Graduate School of Public Health, University of Pittsburgh. In this role I have conducted numerous health and surveillance surveys. My interests are in reducing health disparities, and in this vein I have presented several abstracts and have manuscripts under review and/or in process for publication.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.