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Associations between childhood socioeconomic characteristics, race, and risk of adverse childhood experiences in a population-based sample of US-born non-Hispanic Black and White women

樱花视频 volume听25, Article听number:听1636 (2025) Cite this article

Abstract

Background

Socioeconomically disadvantaged and racially minoritized populations bear an elevated risk of adverse childhood experiences (ACEs), but few studies evaluate whether racial disparities in ACEs persist within socioeconomic strata. We examine the effect of both childhood socioeconomic characteristics and race on ACE burden.

Methods

Data are from a population-based sample (N鈥�= 1381) of US-born non-Hispanic Black (NHB) and White (NHW) women aged 20鈥�49 years in Metropolitan Detroit and Los Angeles County, 2011鈥�2014. Recalled data on ACEs aged <鈥�13 years, childhood household socioeconomic position (chSEP) aged <鈥�13 years, childhood neighborhood poverty rate (cNPR) aged 6听years (based on US Census tract), and covariates were collected during in-person interviews. ACEs are parameterized as an index (i.e., number of adversities, range 0鈥�12) and as individual adversities. We estimate associations between cNPR (鈮� 20%/10- <鈥�20%/< 10%), chSEP index (low/medium/high), race (NHB/NHW), joint cNPR/race, and joint chSEP/race and ACEs using weighted logistic regression, to calculate odds ratios (OR), and using weighted zero-inflated Poisson regression, to calculate estimated ACE index.

Results

Participants who lived in poorer neighborhoods (i.e., cNPR 鈮モ��20%) or households (i.e., low chSEP index) during childhood reported significantly more ACEs than participants in wealthier neighborhoods (i.e., cNPR <鈥�10%) or households (i.e., high chSEP index). NHB vs NHW participants overall had a higher mean ACE index (3.18 vs 2.25, respectively, p鈥�< 0.05), but NHB and NHW participants who lived in poorer neighborhoods or households had a similarly elevated ACE burden (e.g., estimated ACE index for low chSEP was 3.63 [95%CI 1.19鈥�4.97] and 4.16 [95%CI 3.68鈥�4.65], respectively). NHB participants experienced significant discrimination at all levels of cNPR and chSEP, which contributed to their overall increased ACE risk.

Conclusions

US-born NHB and NHW girls residing in poorer neighborhoods or households had a similarly substantially elevated burden of ACEs, indicating childhood poverty is a crucial determinant of ACE risk, independent of race.

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Background

Adverse childhood experiences (ACEs) 鈥� traditionally defined as experiences during childhood of abuse or household challenges (e.g., household member's serious illness, domestic violence) [1] and more recently, experiences of racial discrimination [2, 3] 鈥� have well-established and wide-reaching negative effects on wellbeing throughout life, including increasing risk of depression, obesity, and substance use disorder [1, 4,5,6,7]. They are prevalent in the United States (US): more than half of US adults reported at least one ACE, and over twenty percent reported at least three ACEs, with women reporting 12鈥�15% more ACEs on average than men [8, 9]. Socioeconomic and racial disparities in ACEs are also well documented in the US [9, 10]. Children in households with low socioeconomic position (SEP, e.g., income, highest educational attainment) and racially minoritized children who face greater risk of race-based discrimination (e.g., Black children) report significantly more ACEs than children in households with higher SEP and non-Hispanic White children in national-level data [9, 10]. Although these socioeconomic and racial disparities are well-established, we are only aware of four studies that have evaluated the prevalence or risk of ACEs by childhood household-level SEP and race [11,12,13,14], and no studies have evaluated ACE risk by childhood neighborhood SEP in a population-based sample. Therefore, it is difficult to disentangle the unique contributions of racial identity, household-level SEP, and neighborhood-level SEP to ACE burden.

Childhood exposure to neighborhood- or household-level poverty and race-based discrimination are hypothesized to affect ACE risk largely by impacting the physical, psychological, and relational well-being of their caregivers and families [15,16,17,18,19,20]. Neighborhood poverty is hypothesized to increase ACE risk in part by increasing neighborhood disorder (e.g., deteriorating buildings, public inebriation) and reducing social cohesion [21,22,23,24], which have been associated with increased cumulative psychological and biological stress among residents [24, 25]. Biological stress is, in turn, associated with increased risk for illness, which, when experienced by caregivers, is itself an ACE [17, 26]. Additionally, psychological stress has been associated with heightened risk of engaging in aggressive parenting/caregiver practices, as well as maladaptive coping mechanisms like substance abuse and relational strain that may result in caregiver separation/divorce [21, 27, 28]. Similarly, low household SEP has been associated with greater risk of depression and anxiety among caregivers as well as greater risk of psychological stress, which has been associated with reduced capacity to care for children [16, 29, 30]. Racial disparities in exposure to neighborhood- and household-level poverty 鈥� both products of systemic racism [31]听鈥� are hypothesized to explain much of the observed racial disparities in ACE risk [11, 32,33,34]. Other manifestations of racism, such as disparities in experiences of interpersonal discrimination, beneficial social connections, and risk of imprisonment, have been associated with caregiver wellbeing and may thus also affect ACE risk [31, 35, 36].

There is some evidence that racial disparities in ACEs that have been observed in recent data in the US are not present within strata of household SEP, which supports the hypothesis that racial disparities in ACEs may be largely perpetuated by racial disparities in poverty [11, 12]. Four previous studies have evaluated ACE prevalence [3, 12] or risk [11, 34]听by strata of household-level SEP and race. Two of these studies, which both use national samples of US children, observed that, among children living in poorer households, Black/White disparities in ACE risk are non-significant [11, 12]; one study among Wisconsin women living in low-income households observed that White women experience higher ACE risk than Black women [34]; and the fourth, also among a national sample of US children, finds that Black children in poorer households experience more ACEs [3]. To our knowledge, the joint effect of race and neighborhood poverty on ACE risk has not yet been evaluated.

Here, we examine associations of childhood neighborhood poverty rate (cNPR), childhood household SEP (chSEP), and race with ACE burden in a population-based sample of US-born young non-Hispanic Black and White women from Los Angeles County and Metropolitan Detroit. First, we evaluated the associations of cNPR, chSEP, and race individually with ACE burden to determine whether the socioeconomic and racial disparities in ACE burden observed in national data are reflected in our sample. We hypothesized that neighborhood poverty in childhood, household poverty in childhood, and self-identified non-Hispanic Black race would be associated with elevated ACE burden. Second, we evaluated the influence of childhood socioeconomic characteristics on ACEs by race to determine whether ACE burden is similar among non-Hispanic Black and White women who experienced childhood neighborhood or household poverty burden. We hypothesized that ACE burden would not differ significantly between non-Hispanic Black and White women who experienced neighborhood or household poverty in childhood.

Methods

Data source: the Young Women's Health History Study (YWHHS)

Data are from a population-based sample (N鈥�= 1,381) of non-Hispanic Black (NHB) and White (NHW) women aged 20鈥�49 years (born between 1962 and 1993) living in Los Angeles (LA) County and Metropolitan (Metro) Detroit (Oakland, Wayne and Macomb Counties) who participated in the Young Women鈥檚 Health History Study (YWHHS), a case鈥揷ontrol study of breast cancer. The YWHHS and sample characteristics have previously been described in detail [37,38,39]. Briefly, control participants (the analytic sample of the present study) were sampled using a three-stage area-based probability approach in the LA County and Metro Detroit 2010 US Census (developed with Westat Research Corporation) [37, 40]. Over 24,000 households were sampled, >鈥�18,000 of these were screened, and eligible participants were sampled from the eligible households [37].

To be eligible, participants had to identify as a woman, be US-born, identify as NHB or NHW (see below), be able to complete the interview in English, have no previous cancer diagnosis, not reside in an institution, and be cognitively and physically able to complete the interview [37]. The response rate among sampled control participants was 53%. Demographic information available for 86% of sampled households is incorporated in non-response weights [40]. Women missing information on all ACEs (n鈥�= 4) were excluded from all analyses. The final sample was N鈥�= 1,377 (NHB n鈥�= 662; NHW n鈥�= 715).

Outcome and exposure measures

During in-person computer-assisted personal interviews (80.8% in-home, 19.2% at another location preferred by the participant), participants were asked about their childhood experiences, including ACEs, household socioeconomic position, and residential address. Interviewers used life history calendars to facilitate participants鈥� recall of childhood exposures [41]. Characteristics of childhood neighborhood were derived from historic Census tract information [42].

Outcome

Adverse childhood experiences aged <鈥�13 years

Participants were asked about possible exposure before age 13 years to twelve different ACEs: if their parent or primary childhood caregiver experienced a serious illness, substance abuse, imprisonment, or separation/divorce; whether they themselves experienced the death of a loved one, negative interactions with the police, domestic violence in their childhood home, physical abuse, verbal abuse, or sexual abuse, and personal experience of everyday discrimination (participant reports were not restricted to experiences of perceived racism) and vicarious everyday discrimination (i.e., witnessing a loved one experience discrimination) (see Table听1). For both everyday discrimination ACEs, participants were asked to report the frequency of their experiences in multiple settings. ACE questions were adapted from the Behavioral Risk Factor Surveillance System ACE questionnaire [43], which has been shown to be valid [44], and assessment of childhood everyday discrimination was adapted from a measure previously developed by co-author TPD [45]. In the YWHHS, a study of breast cancer, ACEs were evaluated before age 13 years to capture experiences that precede breast cancer risk factors (e.g., age at first pregnancy and later adolescent body size).

Table 1 Weighted prevalence of ACEs aged <鈥�13 years by sociodemographic characteristics in the YWHHSa
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Risk for ACEs was evaluated using both an ACE index score [46]听(i.e., number of ACEs reported, range 0鈥�12) and as individual ACEs (ever/never or, for experiences of discrimination, higher/lower; see Supplemental Table听1).

Most participants (93.3%) reported that their primary caregiver before age 13 years was one of their biological parents; some reported it was a biological grandparent (0.9%), adopted parent (0.8%), or stepparent (0.3%).

Exposures

Childhood Neighborhood Poverty Rate (cNPR)

Childhood neighborhood was operationalized using participants鈥� Census tract of residence at age 6听years [47,48,49]. In the YWHHS, recalled childhood residence was available at ages 6 and 12 years; we assessed childhood neighborhood poverty at age 6听years because it is the midpoint of the ACE assessment period (< 13 years of age). Participants鈥� recalled addresses at age 6听years were geocoded and linked to Integrated Public Use Microdata Series (IPUMS) report of historic decennial Census tract-level data (i.e., data from the year in which the participant was aged 6听years) on the percentage of residents with income below the federal poverty level (FPL) [42]. Few participants shared a childhood Census tract (average cluster size 1.03 people), so clustering is not expected to affect estimation of standard errors. Neighborhood poverty rate was categorized as <鈥�10% living at or below the FPL (i.e., low cNPR, indicating a low poverty area), 10- <鈥�20%, or 鈮モ��20% (i.e., high cNPR, indicating an area of concentrated poverty) [50]. Linear interpolation was used to estimate poverty rates for non-Census years.

Childhood Household Socioeconomic Position (chSEP)

A chSEP index was created using weighted polychoric principal component analysis with varimax rotation [51, 52]. chSEP indicators represented multiple aspects of the experience of poverty [53, 54]听and were adapted from the National Longitudinal Study of Adolescent to Adult Health [55]听and the National Health and Nutrition Examination Survey [56]. Indicators included whether their household received government assistance, lacked money for essentials (e.g., food or other necessities such as rent or mortgage, electricity, gas/heat), lacked a reliable car, or experienced food insecurity 鈥渁lmost all of the time,鈥� 鈥渕ost of the time,鈥� 鈥渟ome of the time,鈥� 鈥渙nly for a short time,鈥� or 鈥渘ever鈥� before age of 13 years. Only one identified principal component had an eigenvalue of at least 1.0, suggesting unidimensionality of chSEP; this component was used as the chSEP index and categorized by tertiles for analysis. Participants with high chSEP index (i.e., relatively affluent) reported 鈥渘ever鈥� experiencing any of the chSEP indicators assessed. In contrast, among participants with low chSEP index (i.e., relatively poor), 38.7% received government assistance, 15.3% did not have enough money for essentials, and 6.9% went hungry most or almost all of the time before age 13 years (Supplemental Table 2).

Race

Participants who reported that they did not identify as Hispanic/Latina and who selected either 鈥淏lack/African American鈥� or 鈥淲hite鈥� as the race they most identified with were eligible for inclusion in the YWHHS and were categorized as non-Hispanic Black or non-Hispanic White [37]. Other 鈥渞ace鈥� options included American Indian, Native American/Alaska Native, Arab American/Chaldean, East Asian/Southeast Asian, Asian Indian/South Asian, Native Hawaiian/other Pacific Islander, and other.

Joint race/childhood SEP exposures

To evaluate the effect of simultaneous membership in multiple sociodemographic categories (i.e., cNPR and race, chSEP and race) on estimated ACE index score, we used two two-way interaction terms. For analyses of individual ACEs, to ease interpretability given the number of outcomes, we created two six-strata variables that represent combinations of 1) cNPR (< 10%/10- <鈥�20%/鈮� 20%) and race (NHW/NHB) and 2) chSEP (high/medium/low) and race and plotted the adjusted odds ratios to visualize results.

Missing data

No participants lacked data on race, study site, or age. Participants missing data on at least one ACE (n鈥�= 30) were excluded from analyses of the ACE index and participants missing data for any given ACE were excluded from analyses of that adversity. Participants missing cNPR (n鈥�= 187) or chSEP (n鈥�= 44) were excluded from analyses of those exposures. Participants missing cNPR or chSEP were more likely to report 鈮モ��3 ACEs than participants with cNPR or chSEP data but did not otherwise differ by age, race, or the other measures of childhood SEP. (See Supplemental Table 3).

Statistical analyses

We first calculated the weighted average ACE index score and frequency of individual ACEs by sociodemographic exposures. To model associations between sociodemographic characteristics and estimated ACE index scores, we used zero-inflated Poisson regression, which can accommodate a large number of zero values (22.9% of participants reported 0 ACEs), and estimated and plotted the predicted margins [57]. As a sensitivity analysis, to facilitate comparison with previous studies of ACEs that omit experiences of discrimination, we additionally conducted zero-inflated Poisson regression using an ACE index that omitted both discrimination ACEs (range 0鈥�10). To model associations between sociodemographic characteristics and individual ACEs, we used logistic regression. In logistic regression models of joint race/childhood socioeconomic exposures, NHW/low cNPR and NHW/high chSEP were used as the referent because we hypothesize that this group bears the lowest risk of ACEs, based on available literature [9, 11]. Associations of cNPR, chSEP, and race with ACEs were each modeled separately. All regression analyses adjusted for age (continuous) and study site, as potential confounders, and incorporate sample weights [37, 40]. Sample weights reflect the probability of selection based on 2010 Census block characteristics, post-stratified to the weighted totals within each study site, race, and age group [37, 40], and adjust for non-response [40]. Analyses were conducted in SAS (version 9.4; SAS Institute, Inc., Cary, North Carolina) and Stata (version 16.0; Stata Corporation, College Station, TX, USA) software.

The study protocol was approved by the Institutional Review Boards at the University of Wisconsin 鈥� Milwaukee (UWM), Milwaukee, WI (and the Medical College of Wisconsin deferred to UWM); Michigan State University (MSU), East Lansing, MI; Wayne State University (WSU), Detroit, MI; the Michigan Department of Community Health, MI; the University of Southern California (USC) Health Sciences, Los Angeles, CA; the California Committee for the Protection of Human Subjects, CA; and the California Cancer Registry. All study participants provided informed consent.

Results

In our population-based sample, 77.1% of women reported at least one ACE and 40.8% reported at least three ACEs. Almost two-thirds (62.3%) of NHB women, but only 6.7% of NHW women, experienced high cNPR (i.e., cNPR 鈮モ��20%, a high poverty neighborhood), while 49.7% of NHB women and 24.7% of NHW women experienced low childhood household SEP (data not shown).

Table 1 presents the weighted frequencies of ACEs and average ACE index score by participant characteristics. Participants who experienced high cNPR or low chSEP index reported a larger number of ACEs than participants with low cNPR or high chSEP (e.g., weighted mean ACE index score for cNPR 鈮モ��20% vs <鈥�10% 2.93 [95% CI 2.60鈥�3.27] vs 2.10 [95% CI 1.84鈥�2.36]). On average, NHB women reported more ACEs than NHW women (average ACE index scores 3.18 [95% CI 2.83鈥�3.53] vs 2.25 [95% CI 2.01鈥�2.49]). The socioeconomic gradient in ACE prevalence was also observed for individual ACEs, with some exceptions. Namely, the prevalence of caregiver illness, caregiver substance abuse, negative police interactions, physical abuse, and verbal abuse was not significantly different by cNPR, but was by chSEP. For example, 36.9% of participants with low cNPR and 35.3% of participants with high cNPR reported verbal abuse, whereas 50.8% of participants with low chSEP and 29.1% of participants with high chSEP reported verbal abuse. Some individual ACEs were more prevalent among NHW than NHB participants, including caregiver illness (15.2% vs 8.1%, respectively) and physical abuse (19.1% vs 12.8%, respectively), whereas others were more prevalent among NHB than NHW participants, including death of a loved one (28.1% vs 13.7%) and sexual abuse (26.9% vs 15.1%). Additionally, NHB participants experienced significantly more personal (45.0% vs 28.0%, respectively) and vicarious (59.8% vs 12.9%, respectively) discrimination.

Evaluation of socioeconomic and racial differences in ACEs

Figure 1听presents the estimated ACE index score by cNPR, chSEP, and race (estimates presented in Supplemental Table 4). High cNPR and low chSEP were associated with a higher estimated ACE index score than low cNPR and high chSEP. Participants with a high chSEP had the lowest estimated ACE index score (1.57, 95% CI 1.33鈥�1.80) whereas those with a low chSEP had the highest estimated ACE index score (3.89, 95% CI 3.55鈥�4.23). NHB vs NHW women also had a higher estimated ACE index score (3.18, 95% CI 2.85鈥�3.52 vs 2.24, 95% CI 1.99鈥�2.49). When the two discrimination domains are omitted from the index, this racial disparity is attenuated (2.13, 95% 1.86鈥�2.40 vs 1.84, 95% CI 1.62鈥�2.06) (Supplemental Table 4).

Fig. 1
figure 1

Estimated ACE index scores by childhood neighborhood poverty (cNPR), household SEP (chSEP), and race. Weighted and adjusted for age and site. cNPR, chSEP, and race were modeled separately. Estimated ACE index score from weighted zero-inflated Poisson regression. Participants missing childhood neighborhood poverty rate data (n=187) or childhood household SEP index (n=44) were excluded from analyses of cNPR and chSEP, respectively. Participants missing data on at least one ACE were excluded from these analyses (n=30)

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Figure 2听presents adjusted odds of individual ACEs associated with cNPR, chSEP, and race (estimates presented in Supplemental Table 5). High vs low cNPR was associated with higher odds of caregiver separation/divorce, domestic violence, death of a loved one, vicarious discrimination, and sexual abuse (Panel 1), while low chSEP vs high chSEP was associated with higher odds of all ACEs (Panel 2). NHB vs NHW participants had higher odds of reporting caregiver separation/divorce, domestic violence, death of a loved one, both personal and vicarious discrimination, and sexual abuse, and lower odds of reporting caregiver illness (Panel 3).

Fig. 2
figure 2

Adjusted odds ratios of ACEs by childhood neighborhood poverty (cNPR), household SEP (chSEP), and race. Weighted and adjusted for age and site. cNPR, chSEP, and race were modeled separately. Participants missing childhood neighborhood poverty rate (n鈥�= 187) or childhood household SEP index (n鈥�= 44) were excluded from analyses of cNPR and chSEP, respectively. Personal and vicarious experiences of discrimination may be experiences perceived to be motivated by racism, sexism, both racism and sexism, or neither racism nor sexism. NOTE: negative police interaction omitted due to small sample size

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Evaluation of racial differences in ACEs by childhood neighborhood poverty rate and household SEP

Figure 3听presents the estimated ACE index score by joint cNPR and race, as well as joint chSEP and race (estimates presented in Supplemental Table 6). Estimated ACE scores were not significantly different between NHW and NHB women within strata of cNPR (Wald pint鈥�=鈥�0.94; e.g., among women with cNPR <鈥�10%, ACE score =鈥�2.04, 95% CI 1.74鈥�2.32 and 2.79, 95% CI 2.26鈥�3.31, respectively). Among women with high or medium chSEP, NHB women had a significantly higher estimated ACE index score than NHW women (e.g., 2.20, 95% CI 1.92鈥�2.48 vs 1.40, 95% CI 1.13鈥�1.67, respectively, for women with high chSEP) (Wald pint鈥�&濒迟;鈥�0.01). In contrast, among women with low chSEP, estimated ACE index scores were not significantly different between NHB and NHW women (3.63, 95% CI 1.19鈥�4.07 vs 4.16, 95% CI 3.68鈥�4.65, respectively). When discrimination is omitted from the ACE index, however, the racial disparity in estimated ACE score among women with high or medium chSEP becomes non-significant and the estimated ACE index among NHW women with low chSEP is significantly higher than that among NHB women (i.e., 3.48, 95% CI 3.03鈥�3.93 vs 2.53, 95% CI 2.16鈥�2.89) (Supplemental Table 6).

Fig. 3
figure 3

Estimated ACE index scores by joint childhood neighborhood poverty/race and household SEP/race. Weighted and adjusted for age and site. Estimated ACE index score from weighted zero-inflated Poisson regression. Wald pinteraction for the cNPR/race term =鈥�0.94 and for the chSEP/race term <鈥�0.01. Participants missing childhood neighborhood poverty rate data (n鈥�= 187) or childhood household SEP index (n鈥�= 44) were excluded from analyses of cNPR and chSEP, respectively. Participants missing data on at least one ACE were excluded from these analyses (n鈥�= 30)

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Figure听4 presents adjusted odds of individual ACEs by joint cNPR and race (Panel 1) and joint chSEP and race (Panel 2) (estimates presented in Supplemental Table 5). Compared to NHW participants with low cNPR or high chSEP, NHB participants with low cNPR or high chSEP had higher odds of experiencing the death of a loved one and discrimination and lower odds of physical abuse. NHB vs NHW participants with high chSEP also had higher odds of experiencing sexual abuse. NHB and NHW participants with low chSEP had similarly high odds of most ACEs. For some ACEs, however, NHW participants with low chSEP experienced higher odds, while NHB participants did not. These exceptions include caregiver illness, physical abuse, and verbal abuse. In models of cNPR and race, both NHB and NHW participants with high cNPR had higher odds of experiencing caregiver divorce/separation. Estimates for NHB and NHW participants with high cNPR 鈥� compared to NHW participants with low cNPR 鈥� generally did not significantly differ. No other associations reached significance for NHW participants with high cNPR. NHB participants with high cNPR additionally experienced higher odds of experiencing domestic violence, the death of a loved one, discrimination, and sexual abuse and lower odds of physical abuse.

Fig. 4
figure 4

Adjusted odds ratios of ACEs by joint childhood neighborhood poverty/race and household SEP/race. Weighted and adjusted for age and site. Participants missing childhood neighborhood poverty rate (n鈥�= 187) or childhood household SEP index (n鈥�= 44) were excluded from analyses of cNPR and chSEP, respectively. Personal and vicarious experiences of discrimination may be experiences perceived to be motivated by racism, sexism, both racism and sexism, or neither racism nor sexism. NOTE: police interaction omitted due to small sample size

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Discussion

In this population-based study, the first to evaluate the joint effect of neighborhood poverty and race on ACE risk, we observe that childhood poverty is a strong predictor of ACEs before age 13 years. As in previous studies of childhood poverty or race and ACE risk [9, 14, 58], we observed that childhood exposure to neighborhood or household poverty is associated with higher odds of most measures of ACEs and that NHB women reported a larger number of ACEs than NHW women. However, NHB and NHW women who lived in a poor neighborhood (i.e., cNPR 鈮モ��20%) or household (i.e., low chSEP) in childhood had a similarly elevated burden of most measures of ACEs, compared to NHW women with cNPR <鈥�10% or high chSEP. Associations were generally stronger for chSEP than cNPR. Consistent with national racial disparities in SEP [33, 59]听and a history of redlining and racial residential segregation [31, 60, 61], we also observed that NHB women were substantially more likely to live in a poor neighborhood at age 6听years and to experience low chSEP than NHW women. Finally, we observe that NHB vs NHW women have higher odds of experiencing personal and vicarious discrimination at all levels of cNPR and chSEP. This persistent disparity, which has also been observed elsewhere [31, 62, 63], highlights the importance of including assessments of everyday discrimination in measures of ACEs, to fully enumerate adversities experienced in childhood.

Socioeconomic and racial differences in ACEs

The socioeconomic and racial differences in ACE burden that we observe align with those of previous studies of ACE risk by childhood neighborhood characteristics, by household SEP, and by race听[11, 18, 20, 64, 65]. The four studies to evaluate childhood neighborhood characteristics and ACE risk of which we are aware observed that neighborhood disadvantage (e.g., neighborhood disorder, cNPR) was associated with increased risk of ACEs [13, 14, 17, 66]. Three of these studies are in the same cohort of primarily low-income families [14, 17, 66]听and one is in a sample of juvenile offenders [13]. In our population-based sample, we similarly observe that women who lived in a high poverty neighborhood (i.e., cNPR 鈮モ��20%) reported approximately one more adversity than participants in a low poverty (i.e., cNPR <鈥�10%) neighborhood (estimated ACE index score 2.96, 95% CI 2.63鈥�3.28 vs 2.08, 95% CI 1.81鈥�2.35, respectively).

As in previous systematic reviews and nationally representative studies of childhood household SEP and ACE risk, we observe that low chSEP is associated with higher estimated ACE index score and higher odds of all individual ACEs [11, 18, 20, 64, 65]. We also observed that the estimated ACE index score and odds of ACEs associated with low household SEP are even higher than those associated with neighborhood poverty. For example, whereas women who lived in a high poverty neighborhood had an estimated ACE index score of 2.96 (95% CI 2.63鈥�3.28), women with low chSEP had an estimated ACE index score of 3.89 (95% CI 3.55鈥�4.23). chSEP index captures SEP exposure before age 13 years 鈥� the same period for which ACEs are assessed 鈥� whereas cNPR is only assessed at age 6听years, however, and does not capture exposure to neighborhood poverty throughout childhood. We are unable to determine whether low chSEP preceded ACEs that are known to negatively impact a household SEP (e.g., caregiver incarceration, illness), but we observe that low chSEP is also significantly associated with odds of ACEs that are not expected to affect household SEP (e.g., verbal abuse, sexual abuse). Our findings also align with those of cohort studies that were able to assess SEP prior to ACE exposure [14, 67]. Thus, our findings suggest that the inverse association between household SEP and ACE burden that we observe is not likely to be exclusively a result of ACEs causing reductions in household SEP.

Our observation that NHB vs NHW women have a higher estimated ACE index score and higher odds of reporting some, but not all, individual adversities also align with previous systematic reviews and studies using national-level data [8, 9, 12, 18,19,20, 62]. As in these previous studies, we observe that NHB vs NHW women are more likely to report caregiver separation/divorce, domestic violence, death of a loved one, discrimination, and sexual abuse, whereas NHW women are significantly more likely to report caregiver illness and somewhat more likely to report caregiver substance abuse, physical abuse, and emotional (or verbal) abuse [8, 9, 12, 18,19,20, 62, 68]. Racial disparities in experiences of discrimination contribute to the racial disparities in estimated ACE index, as illustrated in Supplemental Table 4. In models that omit the two discrimination ACEs from the index, estimated ACE index score is not significantly different between NHB and NHW women. Additionally, as mentioned previously, racial disparities in ACEs are also hypothesized to be significantly affected by racial disparities in exposure to poverty [11].

Racial differences in ACEs by childhood neighborhood poverty rate and household SEP

As in some previous studies of ACE risk by both SEP and race, we observe that burden of ACEs is not significantly different among NHB and NHW women who lived in a poor household in childhood [11, 12]. This observed similarity between NHB and NHW women in similarly poor contexts has also been reported in studies of other outcomes, including obese BMI and self-rated health [69,70,71,72,73]. Though race has been strongly correlated with childhood neighborhood poverty rate and household SEP in the US [59, 74], which are in turn strongly associated with ACE burden, evaluations of ACE burden by race seldom account for childhood exposure to poverty [3, 11, 12, 34].

To our knowledge, the burden of ACEs by both race and cNPR jointly have not yet been evaluated. In models of ACEs by both cNPR and race, we observe that the burden of ACEs borne by NHB and NHW women who lived in a high poverty neighborhood is not significantly different from each other, though only 6.7% of NHW women lived in a high poverty neighborhood, which limits our ability to draw inferences about this group. The exception is vicarious discrimination, where the odds among NHB women who lived in a high poverty neighborhood is significantly higher than the odds among NHW women who lived in a high poverty neighborhood. Viewing associations between ACEs and both cNPR and race suggests that many of the racial disparities observed among women overall (Fig. 1) may be attributable to racial disparities in poverty. For example, although NHB women overall had higher odds of reporting caregiver separation/divorce than NHW participants overall (Fig. 1), both NHB and NHW women who lived in a high poverty neighborhood experienced elevated odds of caregiver separation/divorce whereas NHB participants who lived in a low poverty neighborhood did not (Fig.听3). In contrast, both NHB women who lived in either a low or high poverty neighborhood (vs NHW women in a low poverty neighborhood) experienced significantly lower odds of physical abuse, but higher odds of personal or vicarious discrimination and death of a loved one. This suggests that factors other than cNPR affect risk of these adversities. It is well established that Black Americans have a higher risk of experiencing racial discrimination than White Americans, irrespective of SEP, so the persistent NHB/NHW disparity in discrimination that we observe here is unsurprising [36, 62, 75]. Relatedly, at all levels of SEP, Black vs White Americans have a higher risk of exposure to concentrated poverty, receiving lower quality health services, exposure to toxic pollutants, and myriad other factors that threaten health and life [31, 36, 60, 76, 77]. These products of racism may well contribute to the persistent racial disparity in death of a loved one that we observe in the present study. Potential causes of the higher odds of physical abuse among NHW vs NHB women that is observed here and elsewhere is less well studied [19, 34, 78]; future studies are needed to evaluate this disparity in physical abuse.

When evaluating ACE burden by both race and chSEP, we also observe that racial disparities in estimated ACE index or individual ACEs are non-significant among non-Hispanic Black and White women with low chSEP. These findings are similar to two of the four previous studies evaluating Black/White differences in prevalence of ACEs by chSEP or risk of ACEs accounting for chSEP [11, 12]. In two studies using recent national data on US children, SEP-adjusted ACE risk was not significantly different between Black and White children [11, 12]. Only one of these four previous studies, which also used recent national data on US children, observed that racial disparities in ACEs persisted [3]. It found that NHB children living below the federal poverty level had higher prevalence of 鈮モ��2 ACEs than similarly poor NHW children (38.6% vs 29.5%) [3]. Though this study excluded emotional, physical, and sexual abuse as well as negative police interactions from its ACE index, it included personal experiences of discrimination and economic hardship. Racial disparities in poverty and in experiences of discrimination likely contribute to the persistent NHB/NHW disparity in ACEs in this sample. In contrast, among a sample of low-income women receiving home visiting services in Wisconsin, NHW women reported a larger number of ACEs on average than NHB women [34]. In this study, the measure of ACEs did include emotional, physical, and sexual abuse, though it excluded experiences of discrimination and death of a loved one. The omission of these ACEs that tend to be more prevalent among NHB populations may contribute to the observed reversal of the racial disparity in ACE index [62, 79]. We too observe that NHW vs NHB women with low chSEP have a higher estimated ACE score when discrimination is omitted from the index (3.48 (95% CI 3.03鈥�3.93) vs 2.53 (95% CI 2.16鈥�2.89), respectively; Supplemental Table 6). Because risk of most ACEs are similar among NHB and NHW women in poor households or neighborhoods and because NHB women disproportionately experience poverty, racial disparities in ACEs, except personal and vicarious discrimination, may be largely attributable to racial disparities in poverty.

Limitations of the present study include reliance on retrospectively reported ACEs, which is typical in studies of ACEs [80], and retrospectively reported childhood household SEP indicators. Agreement between prospective assessments and retrospective recall of ACEs has been observed to be highest when recalled data is obtained via in-person interviews (compared to self-administered questionnaires) [80], as it was in the present study. Data about ACEs was assessed with life history calendars, memory anchoring methods that have been found to improve recall of early life exposures [81, 82]. ACEs were also assessed midway through the interview, after the trained YWHHS interviewers and participants had developed rapport. ACEs were evaluated before age 13 years and so do not capture adversities that may have occurred later in childhood. Available data indicate that rates of child maltreatment decrease gradually throughout childhood, however, with most first reports (i.e., first encounters with Child Protective Services) occurring in early childhood, before age 13 years [83].

An additional limitation is that our measure of childhood neighborhood only reflects exposures at age 6听years, so we are unable to evaluate the effect of duration of exposure to neighborhood poverty on ACE risk. National-level data suggests that White populations in the US tend to experience greater economic mobility than Black populations [84], so age 6 neighborhood-level poverty may be a better indicator of childhood exposure to neighborhood poverty for NHB than NHW women in our sample. Thirteen percent of participants lack information on cNPR, but when we compare those missing cNPR to those not missing cNPR, no significant differences were observed in sociodemographic characteristics (Supplemental Table 3). Those missing cNPR, however, were more likely to report at least three ACEs, which would likely result in an underestimation of the true effects of cNPR on ACE risk.

Study strengths include that our sample is population-based and includes a similar number of US-born non-Hispanic Black and White women in Metropolitan Detroit and Los Angeles County, so findings are generalizable to socioeconomically and racially diverse populations of women. Additionally, we are able to evaluate the joint influence of several indicators of childhood social environment on ACE risk, something few studies have yet been able to do. We were also able to incorporate information on childhood experience of personal and vicarious discrimination, which are important adverse experiences [2, 45, 85, 86], and yet rarely evaluated in studies of ACEs [2]. Additionally, our measure of chSEP, an index of socioeconomic indicators, may be more comparable across racial groups than traditional measures of SEP, such as income or educational attainment [53, 87, 88], because it captures experiences of material deprivation throughout childhood (e.g., food insecurity, lacking money for essentials) rather than factors that may predict deprivation at a single point-in-time measure of chSEP.

Conclusions

Findings from this population-based sample of young socioeconomically diverse non-Hispanic Black and White women indicate that low household SEP in childhood is associated with high ACE exposure before age 13 years. ACE burden is also generally similar among NHB and NHW girls with low household SEP or high neighborhood poverty rate, which illustrates the importance of accounting for poverty when assessing racial differences in ACE prevalence or risk. The persistent socioeconomic gradient in ACE risk that we observe points to reduction in childhood poverty as a critically important strategy for reducing ACEs and associated morbidities [4,5,6, 19, 89]. Indeed, previous studies have observed that policies that reduce household poverty are associated with significant reductions in ACEs [90, 91]. Finally, our observations that non-Hispanic Black girls experience substantial personal and vicarious discrimination at all levels of neighborhood poverty and household SEP underscores the importance of including these measures in studies of adverse childhood experiences.

Data availability

Data are available from the corresponding author upon reasonable request and contingent upon approval by appropriate IRBs.

Abbreviations

YWHHS:

Young Women鈥檚 Health History Study

NHB:

Non-Hispanic Black

NHW:

Non-Hispanic White

SEP:

Socioeconomic position

chSEP:

Childhood household socioeconomic position

cNPR:

Childhood neighborhood poverty rate

ACEs:

Adverse childhood experiences

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgements

We thank the participants and staff of the Young Women鈥檚 Health History Study for their valuable contributions. The authors assume full responsibility for analyses and interpretation of these data.

Funding

The Young Women鈥檚 Health History Study was funded by the National Institutes of Health, National Cancer Institute, Grant number R01 CA136861 (E.M. Velie, Principal Investigator). This work was also supported by the University of Wisconsin 鈥� Milwaukee Distinguished Graduate Student and Distinguished Dissertator Fellowships (L. Marcus Post).

Author information

Authors and Affiliations

  1. Epidemiology Program, Joseph J. Zilber College of Public Health, University of Wisconsin 鈥� Milwaukee, Milwaukee, WI, USA

    Lydia Marcus Post,听D. Phuong Do听&听Ellen M. Velie

  2. Social Work Department, Helen Bader School of Social Welfare, University of Wisconsin 鈥� Milwaukee, Milwaukee, WI, USA

    J. Topitzes

  3. Public Health Policy & Management Program, Joseph J. Zilber College of Public Health, University of Wisconsin 鈥� Milwaukee, Milwaukee, WI, USA

    D. Phuong Do

  4. Community & Behavioral Health Promotion Program, Joseph J. Zilber College of Public Health, University of Wisconsin 鈥� Milwaukee, Milwaukee, WI, USA

    Young I. Cho

  5. Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Dorothy R. Pathak听&听Kelly A. Hirko

  6. Divisions of Community Health Sciences & Epidemiology, School of Public Health, University of California 鈥� Berkley, Berkeley, CA, USA

    Amani Nuru-Jeter

  7. Division of Community Health, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Jamila L. Kwarteng

  8. Dworak-Peck School of Social Work, USC Suzanne, University of Southern California, Los Angeles, CA, USA

    Tyan Parker Dominguez

  9. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  10. Department of Oncology, School of Medicine, Wayne State University and the Karmanos Cancer Institute, Detroit, MI, USA

    Ann G. Schwartz

  11. Departments of Medicine and Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    Ellen M. Velie

Authors
  1. Lydia Marcus Post

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  2. J. Topitzes

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  3. D. Phuong Do

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  4. Young I. Cho

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  5. Dorothy R. Pathak

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  6. Amani Nuru-Jeter

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  7. Jamila L. Kwarteng

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  8. Tyan Parker Dominguez

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  9. Ann S. Hamilton

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  10. Kelly A. Hirko

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  11. Ann G. Schwartz

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  12. Ellen M. Velie

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Contributions

EV, DP, and AH facilitated the acquisition of funding for the original data source and EV, AH, DP, and AS contributed to the acquisition of the data. EV, DP, AH, ANJ, and TPD contributed to the development of the YWHHS questionnaire. For the present study, LMP, advised by PhD supervisor EV and in collaboration with dissertation committee members JT, PD, YC, and DP, developed the analytic plan and interpreted the results. AH, KH, and JK also provided feedback on preliminary drafts of tables. LMP performed the data analyses, prepared the tables and figures, and wrote the first and subsequent drafts of the manuscript text. EV provided substantive feedback on the manuscript. All authors reviewed and edited the manuscript. All authors have approved the submitted version.

Corresponding author

Correspondence to Ellen M. Velie.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Boards at the University of Wisconsin 鈥� Milwaukee (UWM), Milwaukee, WI (and the Medical College of Wisconsin deferred to UWM); Michigan State University (MSU), East Lansing, MI; Wayne State University (WSU), Detroit, MI; the Michigan Department of Community Health, MI; the University of Southern California (USC) Health Sciences, Los Angeles, CA; the California Committee for the Protection of Human Subjects, CA; and the California Cancer Registry. All study procedures were consistent with the Declaration of Helsinki. All study participants provided informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Marcus Post, L., Topitzes, J., Do, D.P. et al. Associations between childhood socioeconomic characteristics, race, and risk of adverse childhood experiences in a population-based sample of US-born non-Hispanic Black and White women. 樱花视频 25, 1636 (2025). https://doi.org/10.1186/s12889-025-22589-4

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  • DOI: https://doi.org/10.1186/s12889-025-22589-4

Keywords

樱花视频

ISSN: 1471-2458

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