Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

Abstract

Background Utilizing Adverse Childhood Experiences (ACEs) measurement scales to assess youths’ adversities has expanded exponentially in health and justice studies. However, most of the ACEs assessment scales have yet to meet critical psychometric standards, especially for key demographic and minority groups. It is critical that any assessment or screening tool is not reinforcing bias, warranting the need for validating ACEs tools that are equitable, reliable and accurate. The current study aimed to examine the structural validity of an ACEs scale. Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), which collected of 97,314 responses collected from adults across sixteen states. This study assessed the psychometric properties and measurement invariance of the ACEs tool under the structural equation modeling framework. Results We found the 11-item ACEs screening tool as a second-order factor with three subscales, all of which passed the measurement invariance tests at metric and scalar levels across age, race, sex, socioeconomic status, gender identity, and sexual orientation. We also found that minority groups experienced more childhood adversity with small effect size, with the exception of the gender identity. Conclusion The ACEs measurement scale from the BRFSS is equitable and free from measurement bias regardless of one’s age, race, sex, socioeconomic status, gender identity, and sexual orientation, and thus is valid to be used to compare group mean differences within these groups. The scale is a potentially valid, viable, and predictive risk assessment in health and justice and research settings to identify high-risk groups or individuals for treatments.

Conceptualizing adverse childhood experiences as a latent factor: Tests of measurement invariance across five racial and ethnic groups

“…Specifically, Ford et al (2014) found that measurement invariance was supported across age and gender identity groups when testing a three-factor latent model of ACEs. Mei et al (2022) replicated this three-factor model across age, race, sex, socioeconomic status, gender identity, and sexual orientation. However, both studies were conducted among adults, resulting in meaningful opportunities to continue exploring measurement invariance related to ACE items among children and youth (Negriff et al, 2022).…”

“…Mei et al. (2022) replicated this three‐factor model across age, race, sex, socioeconomic status, gender identity, and sexual orientation. However, both studies were conducted among adults, resulting in meaningful opportunities to continue exploring measurement invariance related to ACE items among children and youth (Negriff et al., 2022).…”

Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK

“…However, our measure of low household income was affected by around one in three survey participants either not knowing (n=391) or preferring not to report (n=215) their annual household income; consequently, these individuals were categorised in the comparator group for individuals who disclosed an annual income of <£20 000. ACEs were measured retrospectively with a tool that has been widely used in both general and high-risk populations and for which acceptable psychometric properties have been shown in various population groups 41–44. The short ACE tool is restricted by the limited range of ACEs it covers and here we used the initial version of the tool which did not include physical and emotional neglect.…”

Adverse childhood experiences among black sexually minoritized men and Black transgender women in Chicago

“…The measure is commonly used to identify health inequities due to ACE [ 2 , 7 ]. However, it has not been evaluated specifically within Black SMM, nor among any transgender women (TW) [ 8 , 9 ]. There are reasons to believe existing ACE measurements might be inadequate for Black SMMs and may not capture community context, where general racial inequities in ACE exist due to higher incarceration, higher rates of parental absence and separation, other institutional disparities [ 5 , 10 ].…”

“…Furthermore, past studies using population-based data from the BRFSS usually only have a small number of Black SGM participants, limiting the potential generalizability and inference [ 9 ]. These surveys typically used a single item gender identity question, which is deemed inadequate to identify transgender individuals [ 12 ].…”