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." 

by Unknown

The Kids Aren't Alright: Adverse Childhood Experiences and Implications for Health Equity

February 2023:

Authors: Colin Planalp, MPA and Andrea Stewart, MA

Drawing on data from the National Survey of Children’s Health, this brief investigates the prevalence of adverse childhood experiences (ACEs) and disparities in ACEs exposure by children’s race, family income, age and health insurance coverage. The disproportionate impact of ACEs has deep ramifications on health equity due to related research showing that ACEs exposure is associated with increased risk for numerous short- and long-term health impacts, varying from mental health and substance use disorders to heart disease and cancer.

To learn more about disparities in ACEs:

• Download State-level data tables of ACEs prevalence by race and ethnicity, family income, age, and health insurance coverage status;
• Check out the accompanying SHADAC blog "To Improve Health Equity, Treat Disparities in Adverse Childhood Experiences"; or
• Visit the Adverse Childhood Experiences measure on State Health Compare.

 

Array Array
PhD, MA
Principal Investigator

612-624-4802 blewe001@umn.edu

Array Array
Senior Research Associate

schwe425@umn.edu

by SHADAC staff

SHADAC Researchers Co-Author Maternal and Child Health Journal Article on Medical Home Contributions to Child Health Outcomes

SHADAC researchers Natalie Mac Arthur and Lynn Blewett recently published a journal article in Maternal and Child Health Journal that examines the medical home model—a widely accepted model of team-based primary care—and its unique contributions to child health outcomes.  

Their analysis drew on data from the 2016-2017 National Survey of Children’s Health (NSCH) to assess five key medical home components–usual source of care, personal doctor/nurse, family-centered care, referral access, and coordinated care–and their associations with child outcomes. Health outcomes included emergency department (ED) visits, unmet health care needs, preventive medical visits, preventive dental visits, health status, and oral health status.

Key Findings

• Results showed that children who were not white, living in non-English households, with less family income or education, or who were uninsured had lower rates of access to a medical home and its components.
   
• A medical home was associated with beneficial child outcomes for all six of the outcomes and the family-centered care component was associated with better results in five outcomes.
   
• ED visits were less likely for children who received care coordination.

These findings highlight the role of key components of the medical home model and the importance of access to family-centered health care that provides needed coordination for children of all backgrounds. Health care reforms should consider disparities in access to a medical home and specific components and the contributions of each component to provide quality primary care for all children. Understanding the role of medical home components contributes to the refinement of the model and can inform health care policy efforts to improve health equity for all children.    

Read the full article in the Maternal and Child Health journal.

Natalie Schwehr
Senior Research Associate

e schwe425@umn.edu

Neighborhood Support Matters for Child Health

Where people live, work, and play has been shown to have important impacts on health. In addition to one’s physical environment (e.g., access to safe schools, parks, and sources of nutritious food), the extent to which people feel connected to a supportive community with a network of resources is an important factor for health. This concept is known as “social capital," and has been linked with a broad range of health outcomes including mortality.

Neighborhood support is a form of social capital that can be measured with available survey data. The National Survey of Children’s Health (NSCH) is nationally representative and includes children (age 0-17) in all 50 states and the District of Columbia. The data from this survey provide information on family perceptions of neighborhood support and a broad range of child sociodemographic and health characteristics. NSCH data also allow researchers to study the association between supportive neighborhoods and key children’s health outcomes. 

Only about half (55%) of children lived in a supportive neighborhood. As shown in the figure below, the likelihood of living in a supportive neighborhood also varied across population subgroups. Perceived neighborhood support was less likely for non-English households, children of color, children with special health care needs (CSHCN), families with less education or income, and children with public health insurance coverage or who were uninsured.

Percent of children living in supportive neighborhoods, by child characteristics

Source: SHADAC analysis of the National Survey of Children’s Health, 2018-2019

We found that neighborhood support matters for a child’s health. Family perceptions of neighborhood support were significantly associated with four of the five outcomes we examined, after adjusting for child characteristics. Children in supportive neighborhoods were less likely to have a past year emergency department visit or unmet care needs and were more likely to have a preventive dental visit and better parent-reported oral health status (Table below).

Our study provides evidence that neighborhood cohesion is correlated with better child health outcomes. Policies that support healthy neighborhoods and build social capital are essential for the wellbeing of children. This includes policies that benefit child development, such as neighborhood schools, playgrounds, and early childhood education. Community-based programs and health care also play a role in fostering neighborhood support by strengthening networks and linking community members to needed care and resources.

by Unknown

Room to Grow: Inequities in Children's Health Insurance Coverage

September 2022:

Health insurance is a linchpin in the United States’ health care system. It can insulate families from deep financial strain and medical debt, as costs for health care services have grown increasingly unaffordable in recent decades. For children, the doorway to health care offered by insurance is uniquely important—ensuring their opportunity to develop into healthy adults by providing access to regular health screenings, routine services, vaccinations, and vital treatments when health issues are identified.

Children’s health insurance coverage rates in the United States have improved since the 1990s, largely due to policy initiatives designed to provide kids with affordable health insurance options, such as the long-running Children’s Health Insurance Program (CHIP) established twenty-five years ago.¹ However, while overall uninsured rates remain low, disparities among select groups of children have persisted, with wide gaps in coverage found across the states and certain demographic categories.

In this issue brief and accompanying 50-state profiles, SHADAC researchers explore rates of uninsurance among children in the U.S. using 2016-2020 estimates from the U.S. Census Bureau’s American Community Survey (ACS). Aiming to quantify coverage disparities in the states, this analysis looks at rates of uninsurance by race and ethnicity, income as measured by poverty level, citizenship status, age, and metropolitan status. These products can be used to identify health equity gaps and develop policies and initiatives to ensure children have needed access to health insurance and health care.

Uninsured Children by State, 2016-2020

Click on a state in the graphic below to view its kid's coverage profile. Click here to download all 50-state profiles.

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¹ Gates, J.A., Karpman, M., Kenney, G.M., & McMorrow, S. (2016). Uninsurance among children, 1997–2015: Long-term trends and recent patterns. Urban Institute. https://www.urban.org/sites/default/files/publication/79316/2000732-Uninsurance-among-Children-Long-Term-Trends-and-Recent-Patterns.pdf