Racial Disparities in Child Adversity in the U.S.: Interactions With Family Immigration History and Income.
BACKGROUND
Childhood adversity is an under-addressed dimension of primary prevention of disease in children and adults. Evidence shows racial/ethnic and socioeconomic patterning of childhood adversity in the U.S., yet data on the interaction of race/ethnicity and SES for exposure risk is limited, particularly with consideration of immigration history. This study examined racial/ethnic differences in nine adversities among children (from birth to age 17 years) in the National Survey of Child Health (2011-2012) and determined how differences vary by immigration history and income (N=84,837).


METHODS
We estimated cumulative adversity and individual adversity prevalences among white, black, and Hispanic children of U.S.-born and immigrant parents. We examined whether family income mediated the relationship between race/ethnicity and exposure to adversities, and tested interactions (analyses conducted in 2014-2015).


RESULTS
Across all groups, black and Hispanic children were exposed to more adversities compared with white children, and income disparities in exposure were larger than racial/ethnic disparities. For children of U.S.-born parents, these patterns of racial/ethnic and income differences were present for most individual adversities. Among children of immigrant parents, there were few racial/ethnic differences for individual adversities and income gradients were inconsistent. Among children of U.S.-born parents, the Hispanic-white disparity in exposure to adversities persisted after adjustment for income, and racial/ethnic disparities in adversity were largest among children from high-income families.


CONCLUSIONS
Simultaneous consideration of multiple social statuses offers promising frameworks for fresh thinking about the distribution of disease and the design of targeted interventions to reduce preventable health disparities.
Department of Epidemiology and Biostatistics, University of Maryland College Park, School of Public Health, College Park, Maryland. Electronic address: nslopen@umd.edu.
Natalie
N
Slopen
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Center on the Developing Child, Harvard University, Cambridge, Massachusetts; Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts; Harvard Graduate School of Education, Cambridge, Massachusetts.
Jack P
JP
Shonkoff
University of California, San Francisco, School of Medicine, San Francisco, California.
Michelle A
MA
Albert
Department of Applied Psychology, New York University, New York, New York.
Hirokazu
H
Yoshikawa
Georgetown University Medical Center, Washington, District of Columbia.
Aryana
A
Jacobs
Center on the Developing Child, Harvard University, Cambridge, Massachusetts.
Rebecca
R
Stoltz
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
David R
DR
Williams
D000293:Adolescent; D002648:Child; D002669:Child Welfare / Q000208:ethnology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D014481:United States