Adverse Childhood Experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities. Using the Behavioral Risk Factor Surveillance System 2012 survey (N=29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks – depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions— marriage, divorce and separation, educational attainment, income and insurance status—mediate those associations. Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15–20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

The authors used data from the Fragile Families and Child Wellbeing Study to examine whether spanking at ages 1 and 3 is adversely associated with child cognitive skills and behavior problems at ages 3 and 5. Results from cross-lagged path analyses revealed spanking at age 1 to be associated with a higher level of both spanking and externalizing behavior problems at age 3, and spanking at age 3 to be associated with a higher level of both internalizing and externalizing behavior problems at age 5. Additionally, the longer-term associations between spanking at age 1 and behavioral problems at age 5 appeared to predominantly operate through ongoing spanking at age 3. Results for cognitive skills, though less consistent, suggested no association between spanking at age 1 with poorer receptive vocabulary at age 3 or age 5.

Many researchers have examined the cumulative effects of adverse childhood experiences (ACEs) and found that higher levels of ACEs increase the risk for worsening health conditions. Recent research has moved beyond the simple counting of ACEs, to develop a more nuanced understanding of the ways in which ACEs are experienced. Despite evidence that ACEs are experienced differentially by race, limited attention has been paid to these differences. The objective of the current study is to understand whether groupings of ACEs are experienced similarly across racial groups. A subsample of Latinx, Black, and White children were drawn from the National Survey of Children's Health 2016 data release was used as the sample (N ϭ 43,711). The primary measure included in the study were 9 ACE indicators available in the survey. We use descriptive and latent class analysis to examine whether similar clusters of ACEs appear across racial groups. We found that White children had lower exposure to specific ACEs as well as total number of ACEs compared to non-Latinx Black and Latinx Children. In addition, there was not configural similarity between race/ethnic groups and the latent class structure of ACE exposure varies by child race/ethnicity, suggesting important differences by child race. Understanding the disparities in children's experiences can inform screening and intervention development. Public Policy Relevance StatementPrior research has focused almost exclusively on the count of adverse childhood experiences (ACEs) and has failed to recognize important racial differences in these experiences. It is critical that we consider how race may influence ACE exposure and move toward meaningful interpretation of screening as the field simultaneously considers how to better match interventions to meet children's needs.

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