The impacts of adverse childhood experiences on socioeconomic disadvantage by sexual and gender identity in the U.S

Adverse Childhood Experiences and Subjective Cognitive Decline Among Transgender Adults

INTRODUCTION

Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults.

DESIGN

Cross-sectional, secondary analysis of publicly available data.

METHODS

2019-2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (N = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD.

RESULTS

18% (n = 38) of TGN adults in the sample endorsed SCD, 60% (n = 120) experienced any ACE, 20% (n = 41) 1 ACE, and 18% (n = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (n = 94) or household dysfunction (n = 92). Among those with SCD, 34% (n = 13) reported > 4 ACEs, and 73% (n = 26) reported childhood abuse or household dysfunction (n = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2-1.6, p < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88-10.02, p < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00-11.07, p < 0.01).

CONCLUSION

ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD.

CLINICAL RELEVANCE

Examining how adverse childhood experiences impact different aspects of health, including brain health, is important to nursing practice as it can provide clinical care strategies and identify interventions to specifically address ways to improve the health and well-being of transgender and nonbinary people.

Sexual Identity Is Associated With Adverse Childhood Experiences in US Early Adolescents

OBJECTIVE

To determine disparities in adverse childhood experiences (ACEs) by sexual identity in a national cohort of early adolescents.

METHODS

We analyzed cross-sectional data from year 2 of the Adolescent Brain Cognitive Development study (N = 10,934, 2018-20, ages 10-14 years). Disparities in ACE scores across lesbian, gay, or bisexual (LGB), not sure, and heterosexual adolescents were assessed using multinomial logistic regression analyses. Logistic regressions estimated the associations between sexual identity and each individual ACE. Analyses were adjusted for potential confounders.

RESULTS

In adjusted models, LGB adolescents had a higher risk of experiencing 2, 3, or ≥4 ACEs (relative risk ratios [RRR] = 1.57, 95% Confidence Interval (CI) 1.01-2.42), 3 (RR = 1.78, 95% CI 1.100-2.88), or ≥4 ACEs (RRR = 3.20, 95% CI 1.92-5.32), and not sure adolescents had a higher risk of having ≥4 ACEs (RRR = 2.17, 95% CI 1.22-3.87), compared to heterosexual adolescents. LGB and not sure adolescents had higher risks of reporting emotional abuse ("yes" OR = 4.21, 95% CI 1.84-9.61; "maybe" OR = 6.20, 95% CI 2.91-13.19) and parent mental illness ("yes" OR = 1.95, 95% CI 1.48-2.57; "maybe" OR = 1.63, 95% CI 1.21-2.18) compared to heterosexual adolescents.

CONCLUSIONS

LGB adolescents and those questioning their sexual identity were at greater risk of having higher ACE scores, with LGB adolescents experiencing the highest risk of experiencing ACEs. LGB adolescents also had higher odds of reporting emotional and parent mental illness. Recognizing this heightened risk of ACEs in early adolescence is critical for designing clinic and school-based interventions.

Inequities in the distribution of adverse childhood experiences and their association with health among transgender people of color

BACKGROUND

Racism and cisgenderism expose transgender people of color to adversity across the life course. However, little is known about the prevalence of adverse childhood experiences (ACEs) in this population or their association with health in comparison to other groups.

OBJECTIVE

Guided by the structural trauma framework, we examined race/ethnicity/gender group differences in the prevalence of ACEs and their association with adult mental and physical health.

PARTICIPANTS AND SETTING

2019-2021 Behavioral Risk Factor Surveillance Survey.

METHODS

Transgender participants (n = 551) were matched with two cisgender men (n = 1102) and two cisgender women (n = 1102) on key covariates. We compared age-adjusted predicted probabilities of nine ACEs by race/ethnicity/gender group. We then fit adjusted logistic regression models predicting poor mental and physical health by each ACE and compared marginal effects between groups.

RESULTS

Transgender people of color had higher age-adjusted probabilities of six ACEs than at least one other group; for example, household incarceration was 0.16 (95 % CI: 0.11-0.22) compared to 0.09 (95 % CI: 0.06-0.13) for cisgender men of color (p = 0.032). The relationship between five ACEs and poor mental health was greater for transgender people of color than at least one other group. For instance, the marginal effect of household alcoholism on poor mental health was 0.28 (95 % CI: 0.11-0.45) compared to 0.07 (0.01-0.14) for White cisgender men (p = 0.031). There were no statistically significant differences regarding effects on poor physical health.

CONCLUSIONS

ACEs inequitably impact transgender people of color, reflecting the need to restructure the interlocking systems that drive adversity among transgender children of color and exacerbate ACEs' health effects among adults.