Intersectionality and Adverse Childhood Experiences: Comparing Subgroups of Sex, Race/Ethnicity, and Sexual Orientation

The effects of sexual orientation and adverse childhood experiences on short sleep duration: Evidence from the behavioral risk factor surveillance system (BRFSS)

BACKGROUND

Adverse childhood experiences (ACEs) are associated with an increased risk of short sleep duration in adulthood. This study aims to explore the relationship between sexual orientation, ACEs and short sleep duration.

METHODS

61,323 adults from the Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. We measured sexual orientation, ACEs and short sleep duration with participants' self-report. Multivariate logistic regression analysing the effects of sexual orientation, ACEs and their interactions on short sleep duration.

RESULTS

More sexual minoritized individuals reported short sleep duration compared to heterosexual individuals (32.10 % for heterosexuals; 33.70 % for sexual minoritized individuals). More sexual minoritized individuals reported being exposed to >1 ACE (heterosexual = 62.8 %; sexual minoritized individuals = 82.2 %. P < 0.001) than heterosexuals, especially sexual minorities are about three times more likely than heterosexual to be sexually abused (heterosexual = 11.1 %; sexual minoritized individuals = 31.2 %, P < 0.001). More bisexual women reported sexual abuse than bisexual men (38.2 % for bisexual women; 22.6 % for bisexal men). Positive association between ACEs status and short sleep duration (OR:2.23, 95%CI: 1.36,3.65) was identified among sexual minoritized individuals. Those sexual minorities individuals who experienced sexual abuse in childhood, emotional abuse, and mental illness in the household had 1.72, 1.38, and 1.39 times the risk of having a short sleep duration in adulthood as compared to heterosexual household, respectively. Moreover, there was a significant interaction between sexual abuse and sexual orientation.

LIMITATIONS

The cross-sectional design limited the ability to make causal inference.

CONCLUSION

This study shows that sexual abuse experiences suffered by sexual minority adults during childhood may lead to a higher risk of subsequent short sleep duration as well. Thus, the risk of short sleep duration in sexual minorities is reduced by reducing the occurrence of ACEs.

Inflammation and minority stress: A moderated mediation model of childhood adversity and mental health in young men who have sex with men

RATIONALE

Adverse childhood experiences (ACEs) are linked to later anxiety and depression, and inflammation has been implicated as a mediating mechanism. Black and Latinx men who have sex with men (MSM) face higher prevalences of ACEs, anxiety, and depression compared to White, heterosexual peers. Understanding the links between ACEs and mental health is crucial to addressing these disparities.

METHODS

This study used structural equation modeling to test moderated mediation models examining inflammation as a mediator of the relationship between ACEs and symptoms of anxiety/depression and minority stress as a moderator on the path between ACEs and inflammation. Data was from a community sample of Black and Latinx MSM (n = 246; mean age = 22.6).

RESULTS

ACEs were significantly associated with symptoms of anxiety (B = 0.414; p < 0.001) and depression (B = 0.346; p < 0.001), but inflammation did not show a significant mediating effect. Additionally, the interaction between ACEs and minority stress had no significant indirect effect on anxiety/depression.

CONCLUSIONS

These findings underscore the possibility that inflammation may not represent the global perturbations of stress processes after ACEs at younger ages, particularly among a relatively healthy sample of emerging adults.

The Prevalence of Sexual Victimization in Children and Adolescents of Indigenous and Non-Indigenous Peoples in Chile

Chilean studies show high levels of sexual victimization among adolescents. Despite this, there is little research exploring differences between adolescents belonging to Indigenous communities and the general population. This is relevant because 12.8% of the Chilean population is from an Indigenous community. In this study, data from 13,385 adolescents all over the country (15.8% indigenous) were analyzed. The prevalence of seven forms of sexual victimization throughout life was examined. Adolescents from Indigenous communities presented a higher prevalence of statutory rape, sexual abuse by an unknown adult, sexual abuse by a known adult, and rape although the effect size was small in all cases and the difference in prevalence rates was less than 2.5%. The results suggest that although attention should be paid to these differences, factors that may contribute to the vulnerability of adolescents from both groups should be explored. For example, in this study, adolescents from Indigenous communities came from a lower income segment compared to their non-Indigenous peers. In Chile, extreme poverty is associated with vulnerability factors for abuse in adolescents of any ethnic origin, so public programs and policies should consider not only ethnicity, but also other factors such as gender, socioeconomic level, and social support network.

Cognitive and affective links between childhood adversity and psychological adjustment in emerging adults with chronic medical conditions

OBJECTIVE

Childhood adversity has been linked to poor psychological adjustment and decreased emotion regulation (ER) abilities. The extended process model of ER outlines the pivotal role of cognitive appraisals in the generation and expression of emotion as well as the pursuit of ER. The aim of the current study is to examine whether illness-related cognitive appraisals (i.e., illness uncertainty and illness intrusiveness) and emotion dysregulation serially mediate the relationship between childhood adversity and psychological adjustment for emerging adults with chronic medical conditions (CMCs).

METHODS

Participants included 557 undergraduate college students (Mage= 19.53 years, SD = 1.34) enrolled in a Midwestern public university with self-reported CMCs. Participants completed measures of adverse childhood experiences (ACEs), illness uncertainty, illness intrusiveness, emotion dysregulation, anxious symptoms, and depressive symptoms. A path analysis was conducted examining ACEs → cognitive appraisals (i.e., illness uncertainty, illness intrusiveness) → emotion dysregulation → depressive and anxious symptoms.

RESULTS

The overall model was significant and predicted 63.5% of the variability in anxious symptoms and 60.2% of the variability in depressive symptoms. All anticipated direct and indirect paths were significant.

CONCLUSIONS

The current study indicates that greater childhood adversity is indeed associated with negative appraisals of one's CMC, such as greater perceived uncertainty and intrusiveness. Negative illness-related cognitive appraisals thus may limit one's ability to effectively employ adaptive strategies to regulate emotions, which could contribute to greater depressive and anxious symptoms.

Stress Appraisal Mediates the Association Between Adverse Childhood Experiences and Depression Among Black Same-Gender-Loving Men: An African-Centered Interpretation

Black same-gender-loving (SGL) men (BSGLM) bear a disproportionate burden of depression. Adverse childhood experiences (ACEs) have been found to predict depression among this group. However, little research has examined the mechanisms that may account for this relationship. This study aimed to examine how stress appraisal explained the association between ACEs and depression. This cross-sectional study leveraged survey data from 169 BSGLM residing in the United States. Utilizing Hayes' PROCESS Macro (Model 4), we found that five different dimensions of stress appraisal were significant partial mediators of the association between ACEs and depression. Specifically, ACEs predicted lower levels of stress appraisal dimensions consistent with an optimal worldview, which in turn were inversely associated with depressive symptoms. ACEs predicted higher levels of stress appraisal dimensions consistent with a suboptimal worldview, which in turn were positively associated with depressive symptoms. Effects sizes ranged from small to large. Implications of these findings for clinical care and research with BSGLM were discussed.

Adverse Childhood Experiences and Intimate Partner Violence Among Sexual Minority Young Adults: The Roles of Alcohol Consequences and Discrimination

Adverse childhood experiences (ACEs) are associated with intimate partner violence (IPV) perpetration. A posited mechanism explaining the link between ACEs and IPV is alcohol use consequences. Yet, few studies have examined this relationship among sexual minority young adults or how chronic and unique discrimination due to their marginalized identity (i.e., minority stress) may influence these associations. This study examined whether alcohol use consequences mediated the relationship between ACEs and IPV perpetration, and whether minority stress moderated this mediated relationship. Sexual minority young adults who used alcohol in the past month (N = 344; age 18-25) in a dating relationship completed a survey on ACEs, IPV, alcohol and minority stress. We hypothesized: (a) alcohol use consequences would mediate the association between ACEs and IPV perpetration and (b) higher discrimination would moderate the mediation of alcohol use consequences in the relationship between ACEs and IPV perpetration. ACEs (B = 0.74, p = .010) and alcohol use consequences (B = 0.64, p = .007), were significantly associated with psychological, but not physical, IPV perpetration. Alcohol use consequences did not mediate the association between ACEs and any IPV type. In addition, everyday discrimination was not a significant moderator. ACEs and alcohol use consequences contribute to the risk for IPV perpetration among sexual minority young adults. Future research is needed to determine how alcohol use consequences may impact risk for IPV perpetration among those who have experienced ACEs.

Racial/Ethnic Differences in Adverse Childhood Experiences and Mental Health

INTRODUCTION

Racial/ethnic differences exist in the prevalence of adverse childhood experiences (ACEs). However, few studies have examined racial/ethnic differences in the association between ACEs and poor mental health outcomes in young adulthood.

METHODS

Data on 10 self-reported, recalled ACEs (prior to age 18) and current symptoms of depression, anxiety, post-traumatic stress disorder, and sleep problems in early adulthood were collected from 2,020 young adults (age 20-23 years) between January and June 2021 enrolled in a Southern California prospective community-based cohort. Logistic regression models run in 2022-2023 evaluated the association of cumulative (0, 1, 2, 3, 4+ ACEs), grouped (abuse, neglect, household dysfunction), and individual ACE exposure with mental health outcomes; interaction models tested for differences by race/ethnicity.

RESULTS

All ACE exposures (cumulative, grouped, individual ACEs) were associated with increased odds of most mental health symptoms. Significant differences by race/ethnicity emerged for individual and grouped (but not cumulative) ACEs. For example, associations of any abuse-related ACE and emotional and physical abuse with depressive symptoms were greater for Hispanic participants than for those of another race/ethnicity. Further, associations of emotional abuse with sleep problems were greater for Hispanic participants than for Asian American and Pacific Islander participants (interaction ps<0.05). Though not significant, the association of familial incarceration with depression symptoms was higher for AAPI participants than for other racial/ethnic groups (interaction p-value=0.06).

CONCLUSIONS

Evaluation of individual and grouped ACEs reveals important racial/ethnic heterogeneity in associations with mental health outcomes. Findings have implications for targeted prevention efforts for racial/ethnic groups at higher risk for poor mental health.

Association of adverse childhood experiences with poor health condition among middle-aged and elderly adults in the United States: A nationally retrospective cohort study

BACKGROUND

The specific effects of adverse childhood experiences (ACEs) in adulthood and senectitude were less known. We aim to examine the relationship between early ACEs and overall health condition as well as specific dimensions in the middle-aged and elderly population.

METHODS

In the 2019-2021 Behavioral Risk Factor Surveillance System Study, robust Poisson regression models were used to estimate the relationship between ACE exposure and current health status among adults aged 45 ≥ years.

RESULTS

Of the 195,472 participants, 53.8 % were female and the mean age was 65.0 years. Compared to populations without ACE, ACE exposures were more significantly associated with depression (PR: 2.03, 95 %CI: 1.94-2.21), frequent mental health (PR: 1.85, 95 %CI: 1.74-1.97) and subject cognitive decline (PR: 1.99, 95 %CI:1.85-2.14) than with physical health (PR: 1.37, 95 %CI: 1.32-1.44), with dose-response patterns. The association with mental disorder was especially significant among the elderly population.

CONCLUSION

Early ACEs are associated with adverse health outcomes that persist into later life, particularly mental disorders and cognitive decline. Poor mental health may indirectly influence associations with ACEs and cognitive decline as well as physical health. Our findings emphasize the importance of lifelong psychological screening and support for the ACE-exposed middle-aged and elderly population.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

INTRODUCTION

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status.

METHODS

Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status.

RESULTS

Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not.

CONCLUSIONS

The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples

BACKGROUND

Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups.

OBJECTIVE

To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups.

DESIGN

Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age.

PARTICIPANTS

Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate).

MAIN MEASURES

SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool.

KEY RESULTS

Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation.

CONCLUSIONS

Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.

Topical Review: Acute and Chronic Pain Experiences in Transgender and Gender-Diverse Youth

OBJECTIVE

To provide an overview of the existing literature on gender diversity in pediatric acute and chronic pain, propose an ecological systems model of understanding pain in transgender and gender-diverse (TGD) youth, and identify a direction for future work that will address the key knowledge gaps identified.

METHODS

Relevant literature on pain and gender diversity was reviewed, drawing from adult literature where there was insufficient evidence in pediatric populations. Existing relevant models for understanding minority stress, gender and pain, and pain experiences within marginalized groups were considered with the reviewed literature to develop a pain model in TGD youth.

RESULTS

While there is an abundance of literature pointing to increased risk for pain experiences amongst TGD youth, there is comparably little empirical evidence of the rates of pain amongst TGD youth, prevalence of TGD identities in pain care settings, effective pain treatments for TGD youth and unique considerations for their care, and the role intersectional factors in understanding TGD youth identities and pain.

CONCLUSION

Pediatric psychologists are well-positioned to advance the research on acute and chronic pain in TGD youth, make evidence-based adaptations to clinical care for TGD youth with pain, including pain related to gender affirmation, and support colleagues within the medical system to provide more inclusive care.

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.