Area-level deprivation and adverse childhood experiences among high school students in Maryland

Abstract

Background Nearly one-half of Americans have been exposed to at least one adverse childhood experience (ACE) before turning 18, contributing to a broad array of problems spanning physical health, mental and behavioral health, and psychosocial functioning. Methods This was a cross-sectional, survey research study, using 2018 data from a state adolescent health surveillance system, i.e., Maryland Youth Risk Behavior Survey/Youth Tobacco Survey. The population-based sample of Maryland high school students (n = 41,091) is representative at the state and county levels. The outcome variables included five binary measures of ACEs (i.e., food insecurity, parental substance use/gambling, parental mental illness, family member in jail/prison, and caregiver verbal abuse), and number of ACEs. The main exposure variable, area-level socioeconomic disadvantage, was assessed at the county level using a continuous measure of the area deprivation index (ADI). Additional covariates included: rural county status, age, race/ethnicity, sex, and sexual or gender minority (SGM) status. We used mixed-effect multivariate logistic regression to estimate the odds of ACEs in association with socioeconomic deprivation. Models were adjusted for all covariates. Results County-level ADI was associated with 3 of the 5 ACES [i.e., food insecurity (OR = 1.10, 95% CI: 1.07–1.13), parental substance use/gambling (OR = 1.05, 95% CI: 1.02–1.07), and incarceration of a family member (OR = 1.14, 95% CI: 1.09–1.19)]; and with having at least one ACE (i.e., OR = 1.08, 95% CI: 1.05–1.10). Odds of reporting at least one ACE were higher among girls, older adolescents (i.e., aged 16 and ≥ 17 relative to those aged ≤ 14 years), and among SGM, Black, and Latinx students (all ORs > 1.20). Conclusions ACEs greatly increase risk for adolescent risk behaviors. We observed an increased likelihood of adversity among youth in more deprived counties and among Black, Latinx, or SGM youth, suggesting that social and structural factors play a role in determining the adversity that youth face. Therefore, efforts to address structural factors (e.g., food access, family financial support, imprisonment as a sanction for criminal behavior) could be a critical strategy for primary prevention of ACEs and promoting adolescent health.

Cross-sectional associations between screen time and the selected lifestyle behaviors in adolescents

“…The participants were asked to answer whether they eating breakfast or how many glasses of milk they drunk during the past 7 days for the breakfast and milk consumption measurement ( 33 ).…”

Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study

“…Several studies have linked ACEs to chronic diseases such as cancer; sexually transmitted diseases; frequent mental distress and depression; intimate partner violence; suicide attempts; health risk behaviors such as smoking, alcohol abuse, substance abuse, sexual risk-taking, and youth violence; as well as an increased risk of premature mortality before the age of 19 [ 16 , 17 , 18 ]. Indeed, research on ACEs and their consequences is increasingly growing worldwide; however, few studies have focused on rural populations.…”

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

“…The prevalence of ACEs is concentrated among marginalized groups, such as low-income earners, those with no or limited access to health insurance, minority sexual orientation, racial/ethnic minority groups, 92 , 93 and in counties of greater deprivation. 94 This greater prevalence of ACEs reflects structural inequalities, such as disproportionate rates of incarceration among Black and Indigenous populations or greater financial strain among low-income earners and marginalized groups. 95 , 96 The disproportionate contact of the justice system with minority race/ethnicities may compound the deleterious effect of ACEs on a range of health, legal, and economic outcomes, including substance misuse.…”