Colin Planalp
MPA , Research Fellow

p 612-624-4850
e cplanalp@umn.edu

To Improve Health Equity, Treat Disparities in Adverse Childhood Experiences

Twenty-five years ago, a watershed study on adverse childhood experiences (ACEs) first established a relationship between childhood trauma and long-term health impacts that can last well into adulthood.¹ Since then, numerous related studies have corroborated the association between ACEs and mental health and substance use disorders as well as diseases such as cancer, diabetes, and heart disease.²

Today, many public health experts recognize childhood trauma as a public health threat, not so different from the threat posed by infectious diseases such as COVID-19. And, similar to the way that medical science has developed tools such as vaccines to prevent illness caused by pathogens, research has identified strategies that can prevent childhood trauma or provide children and families with tools to limit more lasting harms.³

As with other public health strategies, identifying populations most at risk for harm can help focus interventions to improve people’s health and lives. To do that for ACEs, it is critical to understand disparities in children’s exposure to traumatic experiences.

Disparities in ACEs exposure

In a recent SHADAC study, researchers used data from the federally sponsored National Survey of Children’s Health, which includes questions on several experiences generally considered to be ACEs, such as children’s separation from parents due to death, incarceration, or divorce; exposure to violence in the home or neighborhood; and difficulty affording basic necessities, such as food and housing. Because our aim was to produce estimates of ACEs exposure for different demographic groups, we combined multiple years of the survey (2016-2019) to enhance our ability to produce reliable estimates.

The findings of our analysis were deeply troubling. Nationally, almost half of U.S. children had exposure to at least one ACE, and more than half of children had an ACE exposure in 13 states. There was no state where ACEs were rare; even in Minnesota, the state with the lowest rate, more than one-third of children had exposure to at least one ACE.

Disparities in exposure to potentially traumatic childhood experiences were even larger across demographic groups than across the states. By race and ethnicity, Black children and American Indian and Alaska Native children had the highest rates of ACEs exposure, at 63.7 percent and 63.0 percent, respectively. Meanwhile, Asian children and White children had the lowest rates of ACEs exposure, at 25.0 percent and 40.9 percent, respectively. There were similarly large disparities by family income. Children from households with the lowest incomes (200 percent of Federal Poverty Guideline [FPG] or less) had an ACEs exposure rate of 61.9 percent, while those from families with the highest incomes (400 percent of FPG or higher) had a much lower rate of 26.4 percent. Our analysis also found differences by children’s health insurance coverage status and type, as well as by age groups.

ACEs as a health equity issue

Our study showed clear patterns of disparities in exposure to experiences that can create childhood trauma across a multitude of demographic groups—a finding that, in combination with research demonstrating a link between ACEs and long-term health, suggests that working to reduce the prevalence of ACEs and the harm that they cause could pay dividends in improving health equity.

Fortunately, there is a growing body of research that points to strategies for addressing ACEs. For instance, the U.S. Centers for Disease Control and Prevention (CDC) suggests strengthening economic supports for families and promoting family-friendly work policies; ensuring access to high quality childcare and early childhood education; and giving parents and children a toolbox of healthy skills for coping with short-term stress using social-emotional learning and other evidence-based approaches.⁴

Improving people’s health and lives by addressing the pernicious harm of ACEs will necessarily entail a broader “culture of health” strategy that extends beyond the traditional health care system. But attempting such new approaches may be necessary to break longstanding health equity logjams and provide all children a fair chance at growing into healthy and productive adults.

Download new SHADAC brief "The Kids Aren't Alright: Adverse Childhood Experiences and Implications for Health Equity."