Adverse Childhood Exposures and Self-Rated Health among Immigrants

Background: Adverse childhood exposures (ACES) are associated with poor child development, physical health, mental health problems, stress, and poor coping in adulthood.  Immigrants are disproportionately exposed to ACES, sometimes before immigrating to the United States themselves.  Immigrant children are more likely to have a dramatic change in family structure as the ongoing stressors related to the immigration experience embody themselves across the lifecourse, yet adverse childhood events have remained unexplored as a risk factor for health outcomes in this vulnerable population.  Methods: Data from the 2011-12 National Survey of Children’s Health (N=95,646) were analyzed to examine differences by immigrant generational status in the occurrence of ACES. Multinomial ordinal logit regression was used to examine the relationship between self-reported health and generation status (1^st, 2^nd and 3^rd) while accounting for socio-demographic variables.  Results: After controlling for poverty status and race/ethnicity, 1^st generation children report slightly worse self-reported health compared to 3^rd generation children. 1^st generation children reported significantly fewer ACES compared to 3^rd generation children, such as exposure to a incarcerated parent (11.5% 3^rd, 5.8% 2^nd, 5.6% 1^st; p<0.0001) or substance abuse in the home. However, 1^st generation children are more likely to report experienced racial/ethnic discrimination or a parent death. Overall, children with more ACES had an increased risk of poor health (OR=1.2(1.1, 1.3)), however ACES were not related to health for 1^st generation children, as poverty explained this relationship.  Conclusions:  Further studies are needed to understand the pathways between ACES and health status acrss generations of immigrant families.