Racial/Ethnic Inequities in Adverse Childhood Experiences and Selected Health-Related Behaviors and Problems Among Maryland Adolescents

Abstract

We examined racial/ethnic inequities in the prevalence of adverse childhood experiences (ACEs) and examined the association between ACEs and selected health-related behaviors and problems. Data for this cross-sectional study come from the 2018 Maryland Youth Risk Behavior Survey/Youth Tobacco Survey, a statewide survey of high school students (n = 40,188). ACEs included caregiver verbal abuse and household food insecurity, substance use or gambling, mental illness, and involvement with the criminal justice system. We estimated the prevalence of ACEs overall and by race/ethnicity, and then used multiple logistic regression to determine associations between ACEs and emotional/behavioral problems, adjusting for race/ethnicity. Outcome variables included emotional distress, poor school performance, suicidal ideation, fighting, alcohol use, and marijuana use. More than one fifth of students reported each individual ACE. Differences in the prevalence of ACEs by race/ethnicity were statistically significant (p < .001). More than one fourth (25.8%) reported one of the five ACEs, 15.1% reported two, and 15.4% reported three or more. For each ACE, reporting having experienced it (vs. not) was associated with a >30% higher prevalence for each of the outcome variables. Among students who reported three or more ACEs (relative to none), the odds of emotional distress and suicidal ideation were more than 8 times greater. Among Maryland adolescents, ACEs are common, are inequitably distributed by race/ethnicity, and are strongly linked to behavioral health. Findings suggest the need to monitor ACEs as a routine component of adolescent health surveillance and to refocus assessment and intervention toward “upstream” factors that shape adolescent health.

Dissecting early life stress-induced adolescent depression through epigenomic approach

“…In childhood and adolescence, ELS is not only associated with the heightened risk of adverse health problems [26][27][28][29][30][31][32], including physical illnesses such as headache [33] and asthma [34] but also mental illnesses such as depression, non-suicidal self-injury (NSSI) [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. A meta-analysis that examined the association between ELS and depression in adolescents found that the association between childhood abuse/neglect and depression was much stronger in adolescents than in adults [50].…”

Association Between Concussions and Suicidality in High School Students in the United States

“…Past researchers using data from the YRBS have reported that suicidality in high school students is associated with female sex ( 2 , 4 ), sexual minority status ( 47 – 49 ), adverse childhood experiences ( 50 , 51 ), physical teen dating violence ( 52 ), forced sexual intercourse ( 18 , 53 ), body weight perceptions [both overweight ( 54 , 55 ) and underweight ( 55 )], illicit drug use ( 13 , 18 ), prescription opioid misuse ( 56 – 58 ) [especially in girls ( 59 )], alcohol use ( 15 , 18 , 60 , 61 ), marijuana use ( 13 , 15 , 62 ), bullying ( 18 , 55 , 63 , 64 ) and cyberbullying ( 18 , 55 , 63 – 65 ), frequent physical fighting ( 66 ), excessive television/video game/internet use ( 67 , 68 ), insufficient sleep ( 69 ), and even soft drink consumption ( 70 ). With so many variables being associated with suicidality in youth—especially given the very large national sample allowing the identification of statistically significant findings with small effect sizes—it is not particularly surprising that concussion was also associated in the present study, in univariate analyses, and in prior studies using the 2013 ( 45 ) and 2017 YRBS ( 41 – 43 , 46 ).…”

Trauma-Informed Care

“…Finally, ACEs are inequitably distributed by race and ethnicity, demanding clinicians to embrace the practice of cultural humility 47. Cultural humility turns the lenses of race, culture, and gender upon self rather than other, inviting a stance of curiosity and self-awareness, rather than judgment stemming from implicit bias 48.…”

“…Cultural, Historical, and Gender Issues Finally, ACEs are inequitably distributed by race and ethnicity, demanding clinicians to embrace the practice of cultural humility. 47 Cultural humility turns the lenses of race, culture, and gender upon self rather than other, inviting a stance of curiosity and self-awareness, rather than judgment stemming from implicit bias. 48 Culture and gender also influence TIC needs; WOC nurses should ask patients about gender identification, cultural preferences, and practices.…”