THE EFFECTS OF ADVERSE CHILDHOOD EXPERIENCES ON HEALTH AND SOCIAL OUTCOMES ACROSS GENDER, RACE/ETHNICITY, AND ECONOMIC STATUS

Abstract

Background: Despite extensive research demonstrating that adverse childhood experiences (ACEs) are highly prevalent and exceedingly harmful, several important gaps in the literature remain. First, it is unclear to what degree the effects of ACEs vary among population subgroups. Second, and more specifically, limited attention has been paid to disparities in the effects of ACEs among intersectional strata that reflect unique combinations of social categories such as gender, race/ethnicity, and economic status. Third, although there is strong evidence linking ACEs to health-related outcomes, few studies have examined the socioeconomic consequences of ACEs, much less whether ACEs contribute to racial/ethnic disparities in socioeconomic status. Methods: This dissertation consists of three studies that address the above gaps. Study 1 is a systematic review and meta-analysis that synthesizes subgroup-specific evidence on the associations between ACEs and mental health outcomes. Studies 2 and 3 use data from the National Longitudinal Study of Adolescent to Adult Health to explore variations in the effects of ACEs on health-related and socioeconomic outcomes. Results: Study 1 confirmed that ACEs were significantly associated with adult mental health outcomes, with a particularly strong link to PTSD. The effects of ACEs on mental health were significant across several gender, racial/ethnic, and economic subgroups, with the larger magnitude of association observed in certain subgroups. Study 2 found that gender, race/ethnicity, and economic status significantly moderated the associations between ACEs and health-related outcomes. In particular, economic status clearly stratified subgroups with better or worse health outcomes across varying levels of ACEs. Study 3 further demonstrated that ACEs were associated with poorer socioeconomic outcomes, with some of the negative effects more pronounced among White individuals compared to their Black and Asian American counterparts. Taken together, results of these three studies confirm that ACEs are robustly associated with a broad spectrum of adult outcomes, including both health and social domains. They also deepen our understanding of how these effects vary by gender, race/ethnicity, and economic status. Conclusion: This dissertation addresses key knowledge gaps related to the consequences of ACEs and the populations that bear the greatest burden. The findings have important implications for understanding the origins of health disparities, information that can be used to target and tailor prevention and intervention strategies.