Research Roundup: March 2021
Our monthly column highlights recent studies of Adverse Childhood Experiences (ACEs): causes, consequences, and the interventions that work.
Those of us living in the United States have now experienced nearly a full year of social distancing, shelter-in-place, and other public health measures implemented in the face of the COVID-19 pandemic. Our column this month focuses on how the distribution of ACEs is context-dependent: ACEs vary by space, time, and contextual factors. We first review the changing landscape of ACEs in the United States, published in late 2020. We also review evidence that ACEs vary across states and across urban-rural settings. Finally, we discuss a commentary about the potential effects of the COVID-19 pandemic on children’s experience of ACEs, published last year in a journal of the American Psychological Association (Psychological Trauma: Theory, Research, Practice, and Policy).
Adverse Childhood Experiences: 25 years on
The original ACE study was conducted in California from 1995 to 1997, and was a joint effort of the Centers for Disease Control and Prevention and Kaiser Permanente. More than half of the 13,949 respondents reported experiencing at least one ACE, and one-quarter reported experiencing two or more ACEs. Exposure to ACEs was associated with elevated risk of health risk behaviors, chronic disease, and risk factors for several of the leading causes of death in the United States.
Since the original study, the ACEs framework has emerged as a policy-relevant indicator of childhood abuse, neglect, and household dysfunction. In October of last year, a review of time trends in ACEs over the past several decades was conducted and published in the journal Child Abuse and Neglect. Finkelhor searched several academic databases to collect articles using national data from US government-collected or -supported sources to assess time trends in the prevalence of various adverse childhood experiences.
Evidence from published studies suggests that there have been declines in the occurrence of several ACEs, including parental illness, sibling death, exposure to domestic violence, childhood poverty, parental divorce, serious childhood illness, physical abuse, sexual abuse, physical and emotional bullying, and exposure to community violence in the first decades of the 21st century. Conversely, there have been increases in parental alcohol and drug abuse. Data from the late 20th century also indicate increases in parental incarceration which then remained constant from 2000-2015. Overall, the author concludes that the ACE prevalence across several domains is decreasing in the United States. However, the US lags behind other countries on several indicators, and emerging threats should be monitored closely.
ACEs and the COVID-19 Pandemic
These contextual factors are particularly important to keep in mind in light of the COVID-19 pandemic. Social isolation of parents away from social supports, and increased time at home, may increase the risk of ACE exposure in vulnerable settings. These risks were the subject of a commentary by Bryant and colleagues, available here and well worth a read. While the evidence is still emerging regarding the impact of COVID-19 on children, a rise in intimate partner violence has been documented—and witnessing this violence may have lasting impacts on children. The authors also note that the economic impacts of COVID-19 may pose additional risks, calling back to evidence of rising violence against children during the 2008 economic recession. In the coming months, we can expect the publication of more evidence regarding the effects of COVID-19 on ACEs, including this recent Pediatrics paper detailing trends in emergency visits and hospitalizations for child abuse during the pandemic and an article in the American Journal of Public Health regarding rising food insecurity.
Context matters for Adverse Childhood Experiences. In addressing the root causes of ACEs, it is important to consider who will be most affected, what contextual changes may alter risk, and what policy interventions are most suited to act on these leverage points.
1Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
2Finkelhor, D. (2020). Trends in adverse childhood experiences (ACEs) in the United States. Child Abuse & Neglect, 108, 104641.
3Walsh, D., McCartney, G., Smith, M., & Armour, G. (2019). Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review. J Epidemiol Community Health, 73(12), 1087-1093.
4Crouch, E., Radcliff, E., Probst, J. C., Bennett, K. J., & McKinney, S. H. (2020). Rural‐urban differences in adverse childhood experiences across a national sample of children. The Journal of Rural Health, 36(1), 55-64.
5Waehrer, G. M., Miller, T. R., Silverio Marques, S. C., Oh, D. L., & Burke Harris, N. (2020). Disease burden of adverse childhood experiences across 14 states. PLoS one, 15(1), e0226134.
6Kaiser, S. V., Kornblith, A. E., Richardson, T., Pantell, M. S., Fleegler, E. W., Fritz, C. Q., … & Puls, H. T. (2021). Emergency visits and hospitalizations for child abuse during the CoViD-19 pandemic. Pediatrics.
7Wolfson, J. A., & Leung, C. W. (2020). Food Insecurity During COVID-19: An Acute Crisis With Long-Term Health Implications.
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Doctoral Student, Epidemiology, Mailman School of Public Health
Gloria is an incoming doctoral student in epidemiology at the Mailman School of Public Health. Her recent research includes work with the Global Violence Against Children and Youth Surveys (VACS) and qualitative research involving HIV-positive, formerly incarcerated individuals and the reentry process. She has also previously volunteered at youth correctional facilities in upstate New York.