Does Context Matter to ACEs? The Role of State Economic Context and Selected State Policies in Childhood Adversity


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Childhood adversity is a widespread public health problem in the United States. Half of adults experienced at least one serious adversity during childhood, and a quarter experienced two or more. Childhood adversity, often referred to as adverse childhood experiences (ACEs), has been associated with numerous negative physical and psychological health consequences across the lifespan, including heart disease, adverse mental health conditions, pediatric asthma, cancer, autoimmune disease, and early mortality. However, little is known about the determinants of childhood adversity, and in particular whether—and how—socioeconomic or policy context is related to which children experience ACEs. This dissertation addresses that gap by using the 2011-2012 National Survey of Children’s Health, and state-level data from several other sources, to explore: (1) the relationship between state-level economic characteristics and public policies and ACEs, and (2) whether state-level economic characteristics and public policies moderate the relationship between family socioeconomic status (SES), race/ethnicity, and ACEs. Using multilevel logistic regression modeling, this dissertation found that several state-level economic characteristics and policies were directly correlated with ACEs, with lower state socioeconomic status and less supportive social policies resulting in higher risk of ACEs. This relationship was attenuated and in most cases disappeared with the addition of individual-level covariates. State-level characteristics and policies did moderate the relationship between ACEs, family SES, and race/ethnicity, but in an unexpected direction: some lower-SES children had lower odds of ACEs in low-SES states or states with higher income inequality, and non-Hispanic blacks also had lower odds of ACEs in states with low SES and less generous social policies. Further exploration and confirmation of these surprising results is warranted, as it will help increase understanding of the determinants of ACEs, and inform efforts to prevent and mitigate the effects of this widespread problem.



Adverse Childhood Experiences Policy Socioeconomic Status Race / Ethnicity