Despite an extensive literature describing the detrimental effects of Conventional Adverse Childhood Experiences (ACEs-C) (e.g., abuse, neglect, and household dysfunction) on physical and mental health, large-scale studies have not assessed links to broader measures of well-being. Furthermore, the observed dose-response relationships in physical and mental health outcomes have been found for predominately middle-class Caucasian samples in relatively high-resource environments. The original ACE survey also neglected to assess experiences more common in high-risk contexts (“Expanded” ACEs; e.g., witnessing or victimization in a violent crime, family financial problems). Importantly, although effective preventive interventions like high-quality early education can reduce rates of child abuse and neglect, little is known about how participation affects the incidence and consequences of ACEs. Given the ACE literature’s clear policy and practice implications, these gaps warrant investigation.In light of these gaps, this study longitudinally evaluates 1) associations between ACEs and educational attainment, income, crime, depressive symptoms, smoking, and self-rated health in a primarily African-American sample 2) differential effects of timing and type of ACE, 3) the potential compensatory effects of early childhood intervention on ACEs, and 4) moderation of intervention effects on adult outcomes by sex and demographic risk. Follow-up data were analyzed for 88% of the original 1539 participants in the ChicagoLongitudinal Study (N = 1352), a prospective large-scale investigation of the impact of an early childhood intervention program and early experiences on life-course well-being. Born between 1979 and 1980 in high-poverty neighborhoods, retrospective report and administrative records were used to assess ACEs from birth to 18 and outcomes at age 37. Over two-thirds of the study sample experienced ≥1 Conventional or Expanded ACE (ACEs-CE), and over half experienced ≥1 Conventional ACE (ACEs-C). After controlling for demographic risk and intervention status, participants reporting ACEs were more likely to have poor outcomes than those without ACEs, and for several domains of adult well-being, the relations between ACEs and outcomes increased in a graded fashion. Participants with ≥4 ACEs-C from birth to 18 had a significantly increased likelihood of incarceration (OR = 3.71; p <.06), lifetime smoking history (OR = 3.40; p <.001) and current depressive symptoms (OR = 3.10; p <.05). High ACEs-C experienced only in the early childhood period (≥2 prior to age 5) were also associated with increased likelihood of lifetime incarceration (OR = 2.23; p <.05), smoking (OR = 3.46; p <.001), and current depressive symptoms (OR = 2.56; p <.05). It should be noted that, while Expanded ACEs may be an important and informative type of adversity, they did not substantially increase predictive power over ACEs-C for most outcomes. Child abuse and neglect from birth to 18 related to crime, education and income, whereas household dysfunction was associated with smoking and depression. Participants with any CAN completed, on average, .5 fewer grades than those without CAN (β = -.57; p < .01), and were about half as likely to obtain a BA or AA degree (OR = 0.51; p < .01). They were also about half as likely to make an income above the average entry wage (OR = 0.51; p < 01), and twice as likely to have been incarcerated or arrested for a felony (OR = 2.16; p <.01 and OR = 2.13; p <.001, respectively). Participants in the HD group had nearly twofold increased odds of smoking (OR = 1.79; p <.01) and were over twice as likely to report significant depressive symptoms (OR = 2.19; p <.05) compared to the group without HD. Furthermore, early intervention significantly moderated the association between ACEs-CE and highest grade completed (β = 0.59; p <.05) and attainment of a Bachelor’s or Associate’s Degree (OR = 2.17; p <.05). Overall, these findings suggest that ACEs exert detrimental effects on adult well-being in low-SES children above and beyond the effects of demographic risk and poverty, and speak to the need to continue to support underserved communities in active ways. Although ameliorating poverty and its negative impacts continues to be high priority, greater investments in interventions aimed at reducing the incidence and counteracting the effects of ACEs are also imperative.
University of Minnesota Ph.D. dissertation. June 2018. Major: Child Psychology. Advisors: Arthur Reynolds, Robert Krueger. 1 computer file (PDF); vii, 262 pages.
Adverse Childhood Experiences and Adult Well-Being: Impacts by Type, Timing, and Early Childhood Intervention.
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