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Introduction: Research has linked adverse childhood experiences to a host of negative health out-comes. The present study examines the link between individual and cumulative adverse childhood experience exposure and household food insecurity in a recent, nationally representative sample of children, and whether parent self-rated well-being attenuates these associations. Methods: Data from the 2016 National Survey of Children’s Health were analyzed in 2018 (n=50,212). Information concerning children’s exposure to multiple forms of adversity, household availability of food, and parent self-rated well-being were available in the data. Multinomial logistic regression was performed to analyze the data. Results: Findings suggest that the accumulation of adverse childhood experiences is associated with higher odds of food insecurity, with stronger associations between adverse childhood experience accumulation and moderate-to-severe food insecurity. Compared with no adverse childhood experience exposure, exposure to 3 or more adverse experiences corresponded to an 8.14-fold increase in the RR of moderate-to-severe food insecurity. Self-rated parent physical and mental well-being partially attenuated these associations. Conclusions: Policies aimed at minimizing adverse childhood experience exposure among children may have important collateral benefits in the form of reduced household hunger. Existing nutrition assistance programs may be enhanced by linking children and families to programs that bolster parent and child well-being; addressing community and family violence; and providing support for caregivers to prevent abuse, hardship, and exposure to the criminal justice system.
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RESEARCH ARTICLE
Adverse Childhood Experiences and Household Food
Insecurity: Findings From the 2016 National Survey
of Childrens Health
Dylan B. Jackson, PhD,
1
Mariana Chilton, PhD, MPH,
2
Kecia R. Johnson, PhD,
3
Michael G. Vaughn, PhD
4,5
Introduction: Research has linked adverse childhood experiences to a host of negative health out-
comes. The present study examines the link between individual and cumulative adverse childhood
experience exposure and household food insecurity in a recent, nationally representative sample of
children, and whether parent self-rated well-being attenuates these associations.
Methods: Data from the 2016 National Survey of childrens Health were analyzed in 2018
(n=50,212). Information concerning childrens exposure to multiple forms of adversity, household
availability of food, and parent self-rated well-being were available in the data. Multinomial logistic
regression was performed to analyze the data.
Results: Findings suggest that the accumulation of adverse childhood experiences is associated
with higher odds of food insecurity, with stronger associations between adverse childhood experi-
ence accumulation and moderate-to-severe food insecurity. Compared with no adverse childhood
experience exposure, exposure to 3 or more adverse experiences corresponded to an 8.14-fold
increase in the RR of moderate-to-severe food insecurity. Self-rated parent physical and mental
well-being partially attenuated these associations.
Conclusions: Policies aimed at minimizing adverse childhood experience exposure among chil-
dren may have important collateral benets in the form of reduced household hunger. Existing
nutrition assistance programs may be enhanced by linking children and families to programs that
bolster parent and child well-being; addressing community and family violence; and providing support
for caregivers to prevent abuse, hardship, and exposure to the criminal justice system.
Am J Prev Med 2019;000(000):1
8. © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All
rights reserved.
INTRODUCTION
Adverse childhood experiences (ACEs), which
typically encompass various forms of family dys-
function, child abuse, and child neglect,
1
have
recently captured the attention of policymakers, practi-
tioners, and scholars.
2,3
Research suggests that ACEs are
quite common, with recent estimates indicating that by
adulthood approximately 62% of individuals have experi-
enced at least one form of adversity.
4
Cumulative ACE
exposure has been linked to a wide array of deleterious
outcomes, including physical and mental health prob-
lems,suchastype2diabetes,obesity,depression,internal-
izing and externalizing behaviors, and attention-decit
hyperactivity disorder.
510
It has become evident that the
trauma of such childhood adversities, especially as they
From the
1
Department of Criminal Justice, College of Public Policy, Uni-
versity of Texas at San Antonio, San Antonio, Texas;
2
Dornsife School of
Public Health, Drexel University, Philadelphia, Pennsylvania;
3
Depart-
ment of Sociology, Mississippi State University, Starkville, Mississippi;
4
School of Social Work, College for Public Health and Social Justice, St.
Louis University, St. Louis, Missouri; and
5
Graduate School of Social Wel-
fare, Yonsei University, Seoul, Republic of Korea
Address correspondence to: Dylan B. Jackson, PhD, Department of
Criminal Justice, College of Public Policy, University of Texas at San Antonio,
501 W. Cesar E. Chavez Boulevard, San Antonio TX 78207.
E-mail: dylan.jackson@utsa.edu.
0749-3797/$36.00
https://doi.org/10.1016/j.amepre.2019.06.004
© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights
reserved.
Am J Prev Med 2019;000(000):181
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accumulate within families, constitutes a public health cri-
sis that requires targeted community-based action, careful
screening procedures, and a focus on policymaking that is
trauma informed.
11
An emergent body of research suggests that ACEs may
also be closely related to food insecurity or diminished or
unreliable household availability of adequate, nutritious
food.
1218
Findings at the nexus between ACEs and
household food insecurity are consistent with research
linking ACEs to both economic hardship and poor
health,
810
which have already been shown to be strongly
correlated.
1923
In particular, caregivers who experience
adversities are more likely to report diminished mental
and physical well-being.
2325
Poor parental well-being,
moreover, is a potent predictor of household food insecu-
rity,
19
and a key explanatory factor linking economic
hardship and cumulative ACE exposure among chil-
dren.
26
Thus, it is possible that any linkage between the
accumulation of ACEs and household food insecurity is
wholly or partly explained by parent mental and physical
well-being, although the directionality of these relation-
ships is often difcult to identify. Even so, caregiver physi-
cal and psychological ailments, which tend to co-occur
with accumulated childhood adversities,
2325
may greatly
inform associations between individual and cumulative
ACEs and food insecurity. Despite this possibility, the
potential role of parents perceived physical and mental
well-being in these associations is often overlooked. Fur-
thermore, the empirical literature to date is largely cir-
cumscribed to studies examining isolated adversities
14,23
and studies using local or regional samples.
1214,17
The
objective of the present study is to assess the following:
(1) associations between cumulative ACE exposure and
levels of household food insecurity among a recent,
nationally representative sample of children and their
families and (2) whether parent perceptions of physical
and mental well-being attenuate these associations.
METHODS
Study Sample
Data from the 2016 National Survey of Childrens Health (NSCH)
were analyzed in the year 2018 for the purposes of the present
study.
27
The Appendix contains more information concerning the
sample and how missing data were handled. This study was
approved by the IRB of the University of Texas at San Antonio.
Measures
The 2016 NSCH included one item that asked primary caregivers
about the extent to which household foods were not sufcient for
residents, in terms of quality or amount. Several recent studies
have employed items that distinguish between mild food insecu-
rity (i.e., where household residents sometimes rely on low-cost
foods and consume imbalanced meals) and moderate-to-severe food
insecurity (i.e., where residents report occasional to frequent experi-
ences of hunger).
2830
Regardless of the details of measurement, sin-
gle-item indicators, similar to the item employed in the 2016 NSCH,
have been validated as useful proxy measures for food insecurity.
31,32
In the 2016 NSCH, primary caregivers were asked: which of
these statements best describes the food situation in your household
in the past 12 months? Response options included the following:
(1) we could always afford to eat good nutritious meals, (2) we
could always afford enough to eat but not always the kinds of food
we should eat, (3) sometimes we could not afford enough to eat,
and (4) often we could not afford enough to eat. In accordance
with recent studies, a distinction was made between households
that lacked access to enough food and those that, despite having a
sufcient amount of food, lacked access to nutritious food.
30,33,34
Therefore, respondents who reported that they could sometimes
or often not afford enough to eat were designated as experiencing
moderate-to-severe food insecurity (4.38% of sample; n=2,199),
capturing the type of food insecurity that indicates not having
enough to eat. Respondents who reported that they could always
afford enough to eat, but could not always afford to purchase
nutritious foods, were designated as experiencing mild food inse-
curity (21.32% of sample; n=10,705). Lastly, respondents who
reported being consistently able to afford good, nutritious meals
were designated as being food-secure (74.3% of sample; n=37,308).
Eight measures of ACEs were employed, which have been uti-
lized in recent research on the link between ACEs and maternal
and child health.
35
As was the case with prior iterations of the
NSCH, these items were selected and tested on the basis of the
original adult ACE study (the Behavioral Risk Factor Surveillance
Survey ACE Module). Still, modications were made through an
extensive technical expert panel process and review.
36
These
measures are based solely on caregiver reports, as primary care-
givers were rst asked: to the best of your knowledge, has (CHILD)
EVER experienced any of the following? Then, various forms of
childhood adversity were listed, including the following:
1. parent or guardian divorced or separated;
2. parent or guardian died;
3. parent or guardian served time in jail;
4. saw or heard parents or adults slap, hit, kick, or punch one
another in the home;
5. was a victim of violence, or witnessed violence, in the neighborhood;
6. lived with anyone who was mentally ill, suicidal, or severely
depressed;
7. lived with anyone who had a problem with alcohol or drugs; and
8. treated or judged unfairly because of his or her race or ethnic
group.
After this statement, primary caregivers were given the option
to indicate yes, that the child had experienced this form of adver-
sity, or no, that the child had not experienced this form of adver-
sity. Each ACE was examined as an independent variable in a
subset of analyses. The cumulative effect of ACEs on household
food insecurity was also explored. In these models, respondents
were categorized as experiencing none of the ACEs (68.56% of the
sample; n=34,426), experiencing 1 of the ACEs (18.07% of the sam-
ple; n=9,073), experiencing 2 of the ACEs (6.70% of the sample;
n=3,364), or experiencing 3 or more of the ACEs (6.67% of the
sample; n=3,349). Though the rates of ACE exposure in the present
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study are lower than those of justice-involved youth,
37
they are sim-
ilar to rates of ACE exposure in prior studies examining nationally
representative samples of youth.
7
The secondary hypothesis of the current study pertained to the
relationship between ACEs and household food insecurity and
posited that the well-being of parents may, at least in part, explain
this relationship. Two items pertaining to parent self-rated well-
being were available in the 2016 NSCH. The rst item asked the
respondent parent: in general, how is your physical health?
Response options included the following: (1) excellent, (2) very
good, (3) good, (4) fair, and (5) poor. Similarly, respondent parents
were also asked: in general, how is your mental or emotional
health? Response options also included the following: (1) excellent,
(2) very good, (3) good, (4) fair, and (5) poor. Ultimately, because
of the ordering of the response options, with higher numerical
responses indicating lower well-being, these items were labeled as
low parent self-rated physical well-beingand low parent self-
rated mental well-being,and were included in a subset of models
examining the robustness of the key hypothesized association
between ACEs and household food insecurity. The Appendix pro-
vides a full list of covariates.
Statistical Analysis
First, demographic characteristics of the sample were presented.
Second, bivariate patterns between ACEs and food insecurity were
examined by calculating the proportion of children experiencing
various degrees of food insecurity (i.e., none versus mild versus
moderate-to-severe) by the extent of their exposure to ACEs.
After establishing the nonrandomness of cumulative ACE
exposure, the association between ACEs and childrens exposure
to household food insecurity was re-examined using multivariate,
multinomial logistic regression. Although the primary focus of
the current study was on the accumulation of ACEs and their
association with both mild and moderate-to-severe household
food insecurity, a separate set of estimates for individual ACEs
was also included. Finally, a set of ancillary analyses explored
whether the association between cumulative ACEs and food inse-
curity was attenuated when parent self-rated mental and physical
well-being were taken into account. Thus, the current analysis of
these cross-sectional data was multifaceted to enable a robust test-
ing pattern of the associations between ACEs and food insecurity
among this large, nationally representative sample.
The multinomial logistic regression models employed in the
present study examined the predicted percentage change in the
level of food insecurity (i.e., none versus mild versus moderate-to-
severe) for a 1-unit change in the ACE variable being examined.
For the cumulative ACE measure, estimates are relative to the ref-
erence category of no ACE exposure; for individual ACEs, a 1-
unit change simply entails exposure to that particular ACE relative
to no exposure. All analyses were conducted in Stata, version 15.1.
To account for the complex survey design, sample weights that
adjust for nonresponse, probability of selection, and the demo-
graphic distribution of the target population were employed.
38
RESULTS
The analysis began with the presentation of select partic-
ipant characteristics by history of cumulative ACE
Table 1. Select Participant Characteristics by History of Cumulative ACE Exposure
ACE
Characteristics, % Full sample
None
(68.56%)
1ACE
(18.07%)
2 ACEs
(6.70%)
3+ ACEs
(6.67%)
Child characteristics and household demographics
Child age, years, mean (SD) 9.38 (0.02) 8.51 (0.03) 10.92 (0.05) 11.54 (0.08) 11.82 (0.08)
Child sex (male=1) 51.26 51.43 51.55 51.10 49.46
White 70.34 73.47 66.64 63.62 64.65
Black 6.12 4.34 9.00 10.34 8.66
Hispanic 11.00 9.73 12.70 13.90 13.98
Other race/ethnicity 12.54 12.46 11.66 12.14 12.71
Married, 2-parent household 69.90 90.79 33.17 22.72 11.96
Cohabiting, 2-parent household 4.73 3.32 7.20 8.84 8.63
Other family structure 25.37 5.89 59.63 68.44 79.41
Parental education, mean (SD) 3.47 (0.00) 3.57 (0.00) 3.32 (0.01) 3.18 (0.02) 3.08 (0.02)
Below poverty line 9.17 6.29 12.71 17.48 22.01
Low income 15.60 12.97 19.31 23.21 25.45
Moderate income 31.17 30.89 32.46 31.41 30.29
High income 44.06 49.85 35.53 27.89 22.26
Parental employment 76.64 77.52 78.22 74.07 66.29
Nutrition assistance 12.82 8.62 17.05 24.37 30.69
Parent self-rated well-being, mean (SD)
Low parent self-rated mental well-being 1.85 (0.00) 1.71 (0.00) 2.02 (0.01) 2.22 (0.02) 2.40 (0.02)
Low parent self-rated physical well-being 2.05 (0.00) 1.93 (0.00) 2.21 (0.01) 2.38 (0.02) 2.59 (0.02)
Note: ACE, adverse childhood experience.
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exposure (Table 1). Notably, representation of nearly all
the participant characteristics included in the study var-
ied by level of ACE exposure. After exploring differences
in sample demographics by degree of ACE exposure, the
proportion of children experiencing various degrees of
food insecurity (i.e., none versus mild versus moderate-
to-severe) by degree of ACE exposure was calculated in
an effort to establish a bivariate relationship that does
not yet account for covariates (Figure 1). The ndings
illustrated that, whereas 81% of children exposed to
none of the ACEs were raised in food-secure homes,
only 45% of the children exposed to 3 or more ACEs
were raised in food-secure homes (chi-squared=2,900;
p<0.001). Conversely, both mild and moderate-to-severe
food insecurity became more common as the number of
ACEs increased. For instance, whereas 17% of children
exposed to none of the ACEs were raised in homes char-
acterized by mild food insecurity, 38% of the children
exposed to 3 or more ACEs were raised in homes char-
acterized by mild food insecurity (chi-squared=1,300;
p<0.001). The difference was even larger for moderate-
to-severe food insecurity, with its likelihood increasing
by a factor of 8.5 (i.e., from 2% to 17%) among children
experiencing 3 or more ACEs relative to children
experiencing none (chi-squared=1,800; p<0.001).
Next, to address potential confounding of the associa-
tion between ACEs and food insecurity, the association
between the accumulation of ACEs and childrens expo-
sure to household food insecurity was estimated using
multivariate, multinomial logistic regression models that
accounted for child characteristics and household demo-
graphics (Table 2). Although covariates were suppressed
to conserve space, the analyses revealed that cohabiting,
two-parent household (+), parental education (), each
of the income categories (e.g., high income []), and
nutrition assistance (+) were consistently and signi-
cantly associated with both mild and moderate-to-severe
food insecurity. However, child age, gender, and race, in
addition to parental employment, were not consistently
predictive of household food insecurity. Furthermore,
the results indicated that, relative to children with no
history of ACEs, children with a history of ACEs (and a
greater number of ACEs) appeared to be at signicantly
higher risk of residing in a food insecure household. Spe-
cically, compared to children with no history of ACEs,
the risk of mild household food insecurity (relative to
food security) was 3.70 times higher among children
exposed to 3 or more ACEs (95% CI=2.96, 4.63;
p<0.001). Additionally, exposure to 3 or more ACEs (rel-
ative to none) was associated with an 8.14-fold increase in
the risk of moderate-to-severe household food insecurity
(relative to food security; 95% CI=5.75, 11.52; p<0.001).
Even so, experiencing only one ACE (relative to none)
still corresponded to signicant increases in the risk of
both mild (RRR=1.65; 95% CI=1.39, 1.97; p<0.001) and
moderate-to-severe (RRR=2.16; 95% CI=1.60, 2.91;
p<0.001) household food insecurity. Results displayed in
Table 2 also indicated that the general pattern of statisti-
cally signicant results held for most individual ACEs,
with the exception of parent death. Robustness checks
also revealed that employing a count measure of ACEs
did not alter the substantive ndings. The Appendix pro-
vides results of additional ancillary analyses.
Finally, a subset of analyses examining the degree to
which parent self-rated well-being attenuated associa-
tions between ACE exposure and the different forms of
food insecurity was performed (Table 3). Broadly speaking,
evidence of a notable degree of attenuation emerged.
Figure 1. The percentage of food insecure households by number of ACEs.
ACE, adverse childhood experience.
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Table 2. The Association Between ACEs and Household Food Insecurity
a
Household food insecurity
Variable
Mild
RRR (95% CI)
Moderate-to-severe
RRR (95% CI)
Cumulative ACEs
1ACE 1.65 (1.39, 1.97) 2.16 (1.60, 2.91)
2 ACEs 2.18 (1.73, 2.74) 3.39 (4.33, 4.93)
3+ ACEs 3.70 (2.96, 4.63) 8.14 (5.75, 11.52)
Individual ACEs
Parents divorced/separated 1.61 (1.35, 1 .92) 2.01 (1.56, 2.59)
Parent died 0.80 (0.62, 1.04) 0.68 (0.47, 1.01)
Parent in jail 1.81 (1.48, 2.21) 2.41 (1.81, 3.20)
Witnessed physical violence in the home 2.39 (1.96, 2.93) 3.79 (2.83, 5.07)
Victim of or witnessed violence in the neighborhood 2.18 (1.66, 2.85) 3.33 (2.36, 4.69)
Lived with mentally ill/suicidal person 1.77 (1.75, 2.06) 3.61 (2.79, 4.68)
Lived with someone with drug/alcohol problem 2.17 (1.85, 2.56) 4.02 (3.08, 5.24)
Experienced unfair treatment because of race/ethnicity 2.62 (1.94, 3.55) 3.99 (2.59, 6.16)
Note: Boldface indicates statistical signicance (p<0.05).
a
Models pertaining to cumulative ACE exposure and individual ACE exposure are calculated separately. Models include the following covariates: child
age, child sex, child race/ethnicity (i.e., black, Hispanic, other, with white as the reference category), parent marital status, cohabitation, parents
highest educational attainment, income-to-poverty ratio (i.e., low income, moderate income, high income, with poor [below the poverty line] as the
reference category), parents employment status (employed at least 50/52 weeks in the year), and nutrition assistance (i.e., a measure of WIC or
SNAP assistance in the past 12 months).
ACE, adverse childhood experience; SNAP, Supplemental Nutrition Assistance Program; WIC, Special Supplemental Nutrition Program for Women,
Infants, and Children.
Table 3. The Role of Parent Self-Rated Physical and Mental Well-Being in Attenuating Associations Between Cumulative ACE
Exposure and Household Food Insecurity
a
Household food insecurity
Cumulative ACEs Mild
b
(SE) Moderate-to-severe
b
(SE)
Parent self-rated mental and physical well-being excluded
1ACE 0.504 (0.089) 0.770 (0.153)
2 ACEs 0.778 (0.117) 1.221 (0.191)
3+ ACEs 1.310 (0.114) 2.100 (0.177)
Parent self-rated physical well-being included
1ACE 0.405 (0.093) 0.666 (0.156)
2 ACEs 0.647 (0.126) 1.110 (0.197)
3+ ACEs 1.121 (0.121) 1.894 (0.179)
Attenuation, %
1 ACE 19.64 13.51
2 ACEs 16.84 9.09
3+ ACEs 14.43 9.81
Parent self-rated mental well-being included
1ACE 0.354 (0.094) 0.569 (0.158)
2 ACEs 0.524 (0.126) 0.911 (0.206)
3+ ACEs 1.035 (0.121) 1.694 (0.181)
Attenuation, %
1 ACE 29.76 26.10
2 ACEs 32.65 25.39
3+ ACEs 20.99 19.33
Note: Boldface indicates statistical signicance (p<0.05).
a
Models include all covariates.
b
Unstandardized coefcient.
ACE, adverse childhood experience.
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For instance, in the case of mental well-being, attenuation
analyses indicated that 19.33%32.65% of the association
between ACE exposure and food insecurity was explained
by lower parent self-rated mental well-being. Attenuation
was slightly less pronounced for parent self-rated physical
well-being, ranging from 9.09% to 19.64%. Still, associa-
tions between ACE exposure and household food insecu-
rity remained statistically signicant even after accounting
for parent self-rated well-being, indicating only partial
attenuation.
DISCUSSION
Results show that reports of ACEs (e.g., witnessing
domestic violence, having a parent in jail, experiencing
discrimination) are strongly associated with household
food insecurity. Additionally, the greater the number of
ACEs, the more likely the household is to report both
mild and moderate-to-severe food insecurity. Still, the
ndings reveal that, despite being somewhat less impact-
ful than a multiplicity of ACEs, exposure to a single
ACE is also signicantly associated with an elevated risk
of household food insecurity. These ndings build on
previous research showing a strong association between
caregiver reports of ACEs during their own childhood and
severity of household food insecurity.
17
The present study
also employs a recent, nationally representative sample of
families with children, thereby extending and corroborat-
ing prior research. Findings also reinforce the interconnec-
tedness of ACE exposure, food insecurity, and parent
mental and physical well-being suggested in prior litera-
ture,
1825
further buttressing the need to consider the over-
lap of these processes when developing effective
interventions for both household food insecurity and
ACEs such as abuse, neglect, poor parental mental health,
and incarceration.
39,40
Broadly speaking, the present results point to the need
for expanded nutrition assistance programs that are
trauma informed, and, therefore, move beyond simple
assessments of nutrient intake, disordered eating pat-
terns, and nancial risk or need.
11,40
Nutrition assistance
remains a limited form of intervention to address the
issue of food insecurity, and may not adequately reduce
food hardships among families exposed to a high num-
ber of ACEs. The present ndings suggest that food inse-
curity interventions must go beyond nutrition assistance
to address exposure to ACEs, and that existing nutrition
assistance programming may be more effective at reduc-
ing food hardship if integrated with approaches that link
families to programs that address community and family
violence and provide economic and socioemotional sup-
ports for caregivers to prevent abuse, hardship, and
exposure to the criminal justice system. Indeed,
addressing exposure to ACEs through such comprehen-
sive and two-generation approaches that simultaneously
help caregivers and children will likely improve health and
development over the life course.
41
Limitations
Strengths of this study are that the 2016 NSCH is repre-
sentative of the U.S. population and captures current
family experiences with food hardship and simultaneous
ACEs. This study is limited, however, in that it is cross-
sectional and therefore cannot determine the causal
direction of the relationship between adversity and food
insecurity. Still, as the ACE measures are lifetime
reports, and the item pertaining to food insecurity refer-
ences the 12 months before the survey, it is likely that in
many instances, the ACEs being referred to occurred
before the 12 months before the survey. Even so, this
causal order cannot be veried with these data. Some
recent research, moreover, suggests that household food
insecurity may precede and inuence subsequent child-
hood adversities, particularly family violence.
15,18
Other
research, however, nds evidence of family violence pre-
ceding food insecurity,
23
and forms of adversity in
broader ecologic contexts (e.g., exposure to community
violence) may indeed trickle down to the household and
affect the food environment.
42
Therefore, it is likely that
a more nuanced, reciprocal relationship exists between
these risk factors that cannot currently be teased apart
given the format of the 2016 NSCH data. Despite this
limitation, additional research into common risk factors
that may explain part of the association between ACEs
and food insecurity is needed in an effort to reduce both
ACEs and food insecurity. A related limitation that can-
not be avoided with these data pertains to memory or
recall issues and caregiver awareness of or willingness to
report childrens exposure to adversity, which may com-
promise measurement validity of the ACE measures to
an unknown degree.
CONCLUSIONS
The results of the present study show that ACEs have
strong associations with increased food insecurity and
that food insecurity becomes more severe as ACEs accu-
mulate. This relationship, moreover, appears to be par-
tially explained by parental mental and physical well-
being. In an effort to build upon the current ndings,
scholars should consider future research that focuses on
the effectiveness of targeted interventions that address
food insecurity and ACEs simultaneously, and that
assesses the effectiveness of existing two-generation pro-
grams on reducing food insecurity. Overall, ndings
indicate a close connection between ACEs and food
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insecurity, suggesting that policies must extend beyond
the provision of nutrition assistance and integrate program-
ming that addresses intersecting adversities, such as family
and community violence, incarceration, and discrimination.
ACKNOWLEDGMENTS
No nancial disclosures were reported by the authors of this
paper.
SUPPLEMENTAL MATERIAL
Supplemental materials associated with this article can be
found in the online version at https://doi.org/10.1016/j.
amepre.2019.06.004.
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... Adverse childhood experiences (ACEs) are a public health crisis in the U.S. (Giano et al., 2020). ACEs refer to a broad spectrum of traumatic events that include various forms of abuse (emotional, physical, and sexual), neglect, peer violence, exposure to intimate partner violence (IPV), community violence, and familial instability related to substance abuse or mental illness, living with a family member who has been incarcerated among other factors which occurred before the age of 18 years old (Bryant et al., 2020;Chipalo & Jeong, 2023;Chipalo & Odii, 2023;Chipalo et al., 2024;Chipalo, 2023Chipalo, , 2024aJackson et al., 2019;Lee et al., 2022). ACEs can cause familial dysfunctions that increase the risk of physical, behavioral, and mental health problems (Lee et al., 2022;Chipalo, 2023Chipalo, , 2024a, including food insecurity (Schmidt et al., 2016). ...
... A multitude of studies have found significant associations between ACEs, food insecurity, economic hardship, and poverty in different contexts (Chipalo et al., 2024;Jackson et al., 2018Jackson et al., , 2019Melchior et al., 2007;Pelton, 2015;Schurer et al., 2019), and behavioral and mental health outcomes (Amos et al., 2023;Chipalo & Jeong, 2023;Chipalo, 2023Chipalo, , 2024a. However, the existing literature does not emphasize the intersectionality of ACEs and socio-ecological levels (i.e., individual-, family-, or community-level factors that might correlate with increased participation in social welfare services (safety net programs). ...
... In light of the multitude of previous research studies linking ACEs to wide range of health and food insecurity outcomes (Bryant et al., 2020;Chipalo & Jeong, 2023;Chipalo & Odii, 2023;Chipalo et al., 2024;Chipalo, 2023Chipalo, , 2024aJackson et al., 2019;Lee et al., 2022), it has been hypothesized that experiencing one or more ACEs will significantly increase children's utilization of safety net programs after controlling for socio-ecological factors (covariates) and vice-versa. ...
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Adverse childhood experiences (ACEs) are traumatic events associated with food insecurity, poor health, and socioeconomic challenges. This study estimates the prevalence and associations of ACEs, socio-ecological factors, and children’s utilization of safety net programs in the United States (U.S.). In this study, ACEs are defined as experiencing economic hardships, parental separation or divorce, parental death, parental incarceration; witnessing domestic violence in the home or neighborhood; being victims of violence; living with someone with mental illness, or substance abuse issues; and being mistreated due to race/ethnicity, health conditions/disability, and sexual orientation. The data used for this study was derived from the 2022 National Children’s Health Survey (NCHS). An analytic sample of 54,103 children (51.6% male; average age = 8.6 years) was used. Chi-square tests (cross-tabulations) were used to obtain the prevalence estimates across bivariate. Four logistic regression models were employed to predict significant associations between multiple ACEs, socio-ecological factors, and children’s utilization of safety net programs. The statistical significance was determined at the p-value of 0.05 using SPSS vs.29.0. According to parental reports, 37.2% of children utilized some form of safety net programs. After controlling for other factors in the regression models, experiencing at least one ACE (29%; aOR = 1.43; 95% CI = 1.33–1.53), two ACEs (57%; aOR = 1.87; 95% CI = 1.67–2.09), and three or more ACEs (69.7%; aOR = 2.60; 95% CI = 2.31–2.93) were significantly associated with increased odds of children’s utilization of safety net programs. Similarly, living in households with poverty, food insecurity, unemployed parents, single-parent households, and Spanish-speaking households, and living in metropolitan or run down neighborhoods were significantly associated with higher odds of children’s utilization of safety net programs. However, living in households where parents had at least an associate degree or higher was significantly associated with decreased odds of children’s utilization of safety net programs. This study highlights the importance of implementing comprehensive social welfare programs and policies to mitigate the negative impact of ACEs, reduce poverty, and address food insecurity, which drives children and their families to rely increasingly on safety net programs. Implications for policy and practice are discussed further.
... Parents were asked to indicate yes = 1 if the child has ever experienced this form of adversity, and no = 0, if the child had not experienced this form of adversity. A count measure of ACEs was then created by summing each item to arrive at the total number of ACEs experienced, ranging from 0 to 9. Consistent with prior studies (Jackson, Chilton, Johnson, & Vaughn, 2019;LaBrenz et al., 2019) and due to the non-normal distribution of scores on ACEs, scores of three or more were combined into one category and treated as an ordinal variable (0, 1, 2, and ≥ 3). ...
... (Fuller, Brown, Grado, Oyeku, & Gross, 2019) recently found that one in twenty children (5%) in the US have UHCN. The finding that one in two (50%) children had at least one ACE is also consistent with prior studies (Crouch, Radcliff, Hung, & Bennett, 2019;Hughes et al., 2017;Jackson, Chilton, Johnson, & Vaughn, 2019) and underscores the prevalent nature of ACEs (Butchart, Mikton, Dahlberg, & Krug, 2015). We found support for our hypothesis that, controlling for predisposing, enabling, and need factors, there would be an association between ACEs and UHCN. ...
... Moreover, aces have a profound socioeconomic impact on individuals. For example, those who have experienced a higher ace burden have poorer health care access (hargreaves et al., 2019;schüssler-Fiorenza Rose et al., 2022), greater housing and food insecurity (Jackson et al., 2019), and lower educational and economic attainment (currie & Widom, 2010;sansone et al., 2012). in the U.s., the strongest drivers of disparities in life expectancy between counties are race/ethnicity, socioeconomic status, behavioral and metabolic factors, and health care quality and access. the combination of these factors accounts for a substantial 74% of the variability in life expectancy at birth (Dwyer-lindgren et al., 2017). ...
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Adverse Childhood Experiences (ACEs) are very common and presently implicated in 9 out of 10 leading causes of death in the United States. Despite this fact, our mechanistic understanding of how ACEs impact health is limited. Moreover, interventions for reducing stress presently use a one-size-fits-all approach that involves no treatment tailoring or precision. To address these issues, we developed a combined cross-sectional study and randomized controlled trial, called the California Stress, Trauma, and Resilience Study (CalSTARS), to (a) characterize how ACEs influence multisystem biological functioning in adults with all levels of ACE burden and current perceived stress, using multiomics and other complementary approaches, and (b) test the efficacy of our new California Precision Intervention for Stress and Resilience (PRECISE) in adults with elevated perceived stress levels who have experienced the full range of ACEs. The primary trial outcome is perceived stress, and the secondary outcomes span a variety of psychological, emotional, biological, and behavioral variables, as assessed using self-report measures, wearable technologies, and extensive biospecimens (i.e. DNA, saliva, blood, urine, & stool) that will be subjected to genomic, transcriptomic, proteomic, metabolomic, lipidomic, immunomic, and metagenomic/microbiome analysis. In this protocol paper, we describe the scientific gaps motivating this study as well as the sample, study design, procedures, measures, and planned analyses. Ultimately, our goal is to leverage the power of cutting-edge tools from psychology, multiomics, precision medicine, and translational bioinformatics to identify social, molecular, and immunological processes that can be targeted to reduce stress-related disease risk and enhance biopsychosocial resilience in individuals and communities worldwide.
... ≥3). This measure of exposure to ACEs has been used in previous studies (31,35). ...
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Background Sleep plays a vital role in the well-being of children and adolescents. Researchers have identified adverse childhood experiences (ACEs) as an important factor associated with poor sleep among adolescents. The objective of this study was to examine the mediating role of family resilience on the association between ACEs and insufficient sleep among adolescents in the United States. Methods Data for this study came from the 2018–2019 National Survey of Children's Health (N = 28,097). The outcome variable in this study was insufficient sleep, and the main explanatory variable was exposure to ACEs. The mediating variable was family resilience. Data were analyzed using binary logistic regression. Results Based on parent reports, one in five (22.4%) adolescents did not meet the recommended sleep hours on an average night. About half of the adolescents had no ACEs, 24.2% had one ACE, and 14.6% had three or more ACEs. Controlling for the effect of other factors and family resilience, the odds of having insufficient sleep were 1.63 times higher for children exposed to three or more ACEs (AOR = 1.63, 95% CI = 1.30–2.05). Family resilience partially mediates the association between exposure to ACEs and insufficient sleep. Each additional increase in family resilience decreased the odds of having insufficient sleep by a factor of 12% (AOR = 0.88, 95% CI = 0.86–0.91). Conclusions Family resilience partially mediated exposure to ACEs on insufficient sleep. There are modifiable factors that may improve sleep outcomes among adolescents who have been exposed to adversity. Future research can help elucidate findings and establish the directionality of this association.
... MLM uses maximum likelihood estimation to predict the probability of categorical membership. Dereje [26], Pakravan-Charvadeh et al. [47], Jackson et al. [48] and Singh et al. [49] are some of the researchers who used multinomial logit model to identify factors that influence households' food security status. ...
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This study examines the contribution of eucalyptus tree expansion on rural households' food security status, focusing on the specific context of Ethiopia. Eucalyptus trees pose a significant challenge to the rural food system, warranting investigation. A composite food security indicator was used, and data were collected through household surveys, Focus Group Discussions (FGDs), and Key Informant Interviews (KIIs). Descriptive analysis and multinomial logistic regression models were employed for data analysis. The findings reveal that among the sampled households, 31.2% were classified as food secured, 24.8% as intermediate food secured, and 44.0% as food insecured. Econometric estimations highlight the positive influence of variables such as total land holding and livestock on the likelihood of being in the food secured category. Moreover, a unit increase in income earned from the sale of eucalyptus trees leads to an 8.5% higher probability of being in the intermediate category, while decreasing the likelihood of falling into the categories of food insecurity by 8.1% and food security by 0.4%. Importantly, this study uncovers the diverse consequences of eucalyptus trees across different food security categories, suggesting that the planting of eucalyptus trees for improving rural livelihoods and food security must be tailored to specific household conditions. The research outcomes provide valuable insights for guiding future policies, practices, and research endeavors aimed at achieving a sustainable food system in rural Ethiopia.
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Background Empirical studies have demonstrated associations between ten original adverse childhood experiences (ACEs) and multiple health outcomes. Identifying expanded ACEs can capture the burden of other childhood adversities that may have important health implications. Objective We sought to identify childhood adversities that warrant consideration as expanded ACEs. We hypothesized that experiencing expanded and original ACEs would be associated with poorer adult health outcomes compared to experiencing original ACEs alone. Participants The 11,545 respondents of the National Longitudinal Surveys (NLS) and Child and Young Adult Survey were 48.9 % female, 22.7 % Black, 15.8 % Hispanic, 36.1 % White, 1.7 % Asian/Native Hawaiian/Pacific Islander/Native American/Native Alaskan, and 7.5 % Other. Methods This study used regression trees and generalized linear models to identify if/which expanded ACEs interacted with original ACEs in association with six health outcomes. Results Four expanded ACEs—basic needs instability, lack of parental love and affection, community stressors, and mother's experience with physical abuse during childhood —significantly interacted with general health, depressive symptom severity, anxiety symptom severity, and violent crime victimization in adulthood (all p-values <0.005). Basic needs instability and/or lack of parental love and affection emerged as correlates across multiple outcomes. Experiencing lack of parental love and affection and original ACEs was associated with greater anxiety symptoms (p = 0.022). Conclusions This is the first study to use supervised machine learning to investigate interaction effects among original ACEs and expanded ACEs. Two expanded ACEs emerged as predictors for three adult health outcomes and warrant further consideration in ACEs assessments.
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Background and Objectives Individuals of color and of low socioeconomic status are at greater risk of experiencing community violence and food insecurity, which are both influenced by neighborhood conditions. We evaluated neighborhood collective efficacy as a linkage between community violence exposure and household food insecurity. Methods Mothers from the Future of Families and Child Wellbeing Study who completed phone surveys when the child was 3 (time 1, T1) and 5 years old (time 2, T2) were included (n = 2068). A covariate-adjusted structural equation model estimated direct and indirect effects of community violence exposure on household food insecurity. A covariate-adjusted multiple mediator model estimated the indirect effects of the 2 neighborhood collective efficacy subscales (informal social control; social cohesion and trust). Results At T1, 40% of mothers reported community violence exposure; 15% experienced food insecurity at T2. Mean neighborhood collective efficacy (range 1-5) at T1 was 2.44 (SD = 0.94). Neighborhood collective efficacy indirectly influenced the association between community violence exposure and food insecurity (indirect effect = 0.022, 95% CI = 0.007 to 0.040). Only social cohesion and trust contributed independent variance to the indirect effect model (indirect effect = 0.028, 95% CI = 0.001 to 0.056). Conclusions Community-based efforts to reduce household food insecurity should emphasize building social cohesion and trust in communities experiencing violence.
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Extensive research supports a strong and cumulative relationship between adverse childhood experiences (ACEs) and risky adult behaviors, mental health disorders, diseases, and health status. Additional factors, such as poor maternal wellbeing and economic hardship, compound the detrimental health and wellbeing implications associated with childhood exposure to ACEs. However, limited research has explored the differentiating effects of economic hardship and maternal wellbeing on a child’s cumulative ACE exposure. This study examined the differing effects of poor maternal wellbeing and economic hardship on a child’s exposure to ACEs. This study used a random sub-sample (n = 4000) from the 2011 to 2012 National Survey on Children’s Health (NSCH), a nationally representative cross-sectional study of children (N = 95,677) between birth and 17 years old. Confirmatory factor analysis results revealed greater economic hardship had a significant direct effect on a child’s ACE exposure and poorer maternal wellbeing. Poor maternal wellbeing had a significant mediation-like effect on the relationship between economic hardship and a child’s cumulative ACE exposure. Practice and policy implications include early ACE assessments tailored to identify children and families experiencing adversity across multiple domains.
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Importance Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. Objective To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states. Design, Setting, and Participants Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017. Main Outcomes and Measures The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region. Results Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%). Conclusions and Relevance This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations.
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Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children’s behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children’s behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children’s behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children’s internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children’s behavioural psychopathology.
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