title: Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban population.
abstract: Adverse Childhood Experiences (ACEs), which include family dysfunction and community-level stressors, negatively impact the health and well being of children throughout the life course. While several studies have examined the impact of these childhood exposures amongst racially and socially diverse populations, the contribution of ACEs in the persistence of socioeconomic disparities in health is poorly understood. To determine the association between ACEs and health outcomes amongst a sample of adults living in Philadelphia and examine the moderating effect of Socioeconomic Status (SES) on this association, we conducted a cross-sectional survey of 1,784 Philadelphia adults, ages 18 and older, using random digit dialing methodology to assess Conventional ACEs (experiences related to family dysfunction), Expanded ACEs (community-level stressors), and health outcomes. Using weighted, multivariable logistic regression analyses along with SES stratified models, we examined the relationship between ACEs and health outcomes as well as the modifying effect of current SES. High Conventional ACE scores were significantly associated with health risk behaviors, physical and mental illness, while elevated Expanded ACE scores were associated only with substance abuse history and sexually transmitted infections. ACEs did have some differential impacts on health outcomes based on SES. Given the robust impact of Conventional ACEs on health, our results support prior research highlighting the primacy of family relationships on a child's life course trajectory and the importance of interventions designed to support families. Our findings related to the modifying effect of SES may provide additional insight into the complex relationship between poverty and childhood adversity.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Wade
authors.affiliation: Department of Family Medicine and Community Health, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Cronholm
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Fein
authors.affiliation: Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Forke
authors.affiliation: Robert Wood Johnson Foundation, Princeton, NJ, USA.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Davis
authors.affiliation: Public Health Management Corporation, Philadelphia, PA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Harkins-Schwarz
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, PA, USA; Department of Pediatrics, Drexel University School of Medicine, Philadelphia, PA, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Pachter
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Bair-Merritt
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D000069581:Exposure to Violence / Q000523:psychology; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000523:psychology; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D012959:Socioeconomic Factors; D014504:Urban Health; D055815:Young Adult
keywords: Abuse; Childhood adversity; Health outcomes; Socioeconomic Status; Violence