Abstract
Background:
Adverse childhood experiences (ACEs) are stressors that can have lifelong detrimental health effects. ACEs are a concern for children of immigrant parents.
Methods:
The low-income mothers of 75 rural farmworker and 63 urban non-farmworker 8-year old Latinx children in immigrant families completed a standardized ACEs inventory.
Results:
47.1% of mothers reported no ACEs, 33.3% reported 1, 8.7% reported 2, and 10.9% reported 3 or more. A logistic regression model indicated that urban versus rural children had a higher odds (OR=2.35, 95% CI=1.01,5.48) of at least one ACE. Children living in families with 2 versus 1 adults (OR=0.10, 95% CI=0.02,0.49) and 3 versus 1 adults (OR=0.12, 95% CI=0.02,0.78) had a lower odds of at least one ACE.
Discussion:
ACEs prevalence was similar to other children in immigrant families, with children living in urban communities having twice the likelihood of experiencing an ACE. Detailed research is needed on locality-based ACEs prevalence.
Keywords: child health, immigrant health, health disparities, rural-urban differences, Latinx, farmworkers
Introduction
Adverse childhood experiences (ACEs) are life stressors during childhood that have potential lifelong detrimental health effects [1–3]. Examples of ACEs include emotional, physical, and sexual abuse, as well as exposure to family substance abuse, mental illness, exposure to violence, parental separation, and family member’s incarceration [2]. The influence of these negative experiences can persist into adulthood, and they are associated with elevated risk for poor health behaviors, chronic medical problems, and mental health outcomes [4–6]. The 2017–2018 National Survey of Children’s Health found that one in three children in the United States (US) under the age of 18 years reported at least one ACE, and 14% reported two or more ACEs [7]. Identifying ACE exposures promptly can initiate early interventions and potentially minimize ACEs’ long-term consequences [8].
Latinx children in immigrant families (children with at least one immigrant parent who identifies as Latinx) in the US often confront family, social, and financial difficulties that have been associated with ACEs [1, 3, 9–12]. However, research results on the associations of these difficulties with reported ACEs differ. Simply being from an immigrant Latinx family does not necessarily increase the level of ACEs a child experiences. The odds of reporting two or more ACEs versus no ACEs for children in Latinx immigrant families is half that of US-native children [1]. The proportion of Latinx children (those in immigrant families as well as those not in immigrant families) who experience at least one ACE is less than that of non-Latinx black children, but greater than that of non-Latinx white children [10]. Similarly, the proportion of Latinx children in immigrant families who experience two or more ACEs is similar to that of non-Latinx black children (about one-third in each population), but greater than the proportion of non-Latinx white children (about one-in-ten) [10].
A child’s relative US generation, immigrant/first-generation, child of immigrant/second generation, grandchild of immigrant/third generation, is important to the likelihood of experiencing ACEs among children in Latinx immigrant families [3]. For example, Loria and Caughy [3] examined ACEs reported for first, second, and third-generation low-income Latinx immigrant children. These Latinx children experienced an increase in ACEs over succeeding generations, with 23% of first-generation immigrant children reporting two or more ACEs, 17% of second-generation children, and 39% of third-generation children. Differing from other research [10], Loria and Caughy [3] report the proportion of third-generation Latinx children who reported two or more ACEs was comparable to non-Latinx white (36%) and non-Latinx black (35%) children.
Child’s age and economic hardship are associated with the prevalence of ACEs among children of US Latinx immigrants. Older children have more time to accumulate ACEs than do younger children [13]. Economic hardship is the most prevalent ACE reported, with lower household income associated with greater ACEs [13]. Children living in poverty have higher exposures to divorce, violence, and familial disruption [8]. Wade et al. [14] determined that low-income urban children face great exposure to abuse, neglect, and other childhood adversities, with these children often experiencing stressful familial relations, community stressors like neighborhood violence and crime, and personal victimization during their childhood.
Investigations of rural-urban differences in the prevalence of ACEs among Latinx children in immigrant families remain limited [5, 8, 15]. Some research with non-Latinx rural residents indicates that rural areas experience more ACEs than urban areas [5, 15]. Children who reside in rural areas have increased exposure to parental divorce or separation than do their urban and suburban counterparts [8]. Close to 40% of adult Latinx immigrants living in a predominantly rural area of California experienced three or more ACEs [16], a greater prevalence than that reported for the adult US population [2, 7].
This analysis uses data for low-income Latinx immigrant children residing in North Carolina to examine rural-urban differences in ACEs prevalence. It has three aims. The first aim is to describe the level of ACEs among Latinx children living in rural farmworker families and urban non-farmworker families. The second aim is to delineate factors associated with ACEs among Latinx children living in rural farmworker families and urban non-farmworker families. The final aim is to assess specific experiences that are indicators for children reporting three or more ACEs.
Methods
This analysis uses data from the baseline component of PACE5. PACE (Preventing Agricultural Chemical Exposure) is a community-based participatory research study begun in 1996 to investigate and mitigate pesticide exposure among the members of migrant and seasonal farmworker families [17]. The primary PACE partners are the North Carolina Farmworkers Project (Benson, NC; https://ncfwp.org/), and Wake Forest School of Medicine. The objective of PACE5 is to document the association of pesticide exposure with the brain and neurocognitive development of Latinx children in rural farmworker families in comparison with Latinx children in urban non-farmworker families. ACEs was measured in the larger study because it may be associated neurocognitive development [18]. The Wake Forest School of Medicine Institutional Review Board approved the PACE5 protocol and procedures.
Participant Recruitment
Inclusion criteria were similar for rural farmworker (rural) and urban non-farmworker (urban) participants. Participants had to be aged 8 years at baseline, and had to have completed the first grade of school in the US. All participants had to be from families that self-identified as Latinx, and had family incomes below 200% of the Federal Poverty Level. Among participants in rural families, the mother or her partner living in the same house as the child had to be employed in farm work on non-organic farms during the past three years. Among children in urban families, adults living in the same house as the participant could not have been employed in an industry that involves routine exposure to pesticides (e.g., farm work, landscaping, pest control) in the previous three years. The urban families also could not have lived adjacent to agricultural fields in the previous three years. Children were excluded from the study if they had a life threatening illness, prior history of neurological conditions, physical condition or development disorder that would not allow them to complete or would interfere with the results of neurobehavioral tests or brain imaging (used in the main study), primary language other than Spanish or English spoken in the home, or refusal of mother to complete the questionnaires.
Recruitment was completed from March 2018 through December 2019. The rural participants resided in eastern North Carolina, in the counties surrounding the town of Benson. The urban participants resided in central North Carolina, in the counties surrounding the city of Winston-Salem. To recruit children in rural families, the North Carolina Farmworkers Project developed a list of Latinx farmworker families with an 8-year-old child. In addition, other community organizations that served farmworker families in the recruitment area provided lists of potential families. For the urban sample, local recruiters and community members in Winston-Salem developed a list of Latinx families with an 8-year-old child. For both samples, bilingual staff members contacted parents to ensure that they met the inclusion criteria, explained the overall study procedures, answered questions, and, if the parents agreed to participate, obtained signed informed consent from the parents and assent from the child. Because project staff worked through community partners, the number of potential participants or their parents who refused to participate is not known.
Data Collection
The baseline visit included an interviewer-administered life history calendar [19] and an interviewer-administered questionnaire completed with the participant’s mother. The participants’ parents received a cash incentive of $20 for completing the life history calendar and questionnaire. Interviewers were bilingual native Spanish speakers. They completed training before data collection began. Training included didactic instruction on the participant inclusion criteria, recruitment procedures, and life history calendar and questionnaire content. Interviewers completed audio-recorded practice life history calendars and questionnaires before the start of data collection.
The life history calendars collected information on participants’ environmental exposures from conception to date of the interview using an open-ended format [19]. The questionnaire included items about the child’s and family’s demographic and background characteristics. It also included a standard nine-item inventory of adverse childhood experiences [3, 20]. Spanish-language items and scales were adapted from existing questionnaires when available [21]. New items were developed in English, translated into Spanish by a native Spanish speaker, and back translated into English by a native English speaker.
Community partners reviewed the data collection instruments. Seven Spanish-speaking individuals from rural and urban communities completed pre-test interviews. Questionnaire items were revised based on the review and pre-testing. Interviewers entered data in real time during the interviews using Research Electronic Data Capture (REDCap) [22].
Measures
ACEs were measured using a 9-item adverse childhood experiences inventory [3, 20]. The items indicated whether the child had ever experienced financial hardship, parents being divorced or separated, a parent death, a parent in jail, domestic violence, neighborhood violence, mental health illness in the home, substance abuse in the home, or discrimination. Positive responses were summed. The measure used for statistical analysis has the dichotomous categories of no ACEs versus any ACEs. In addition, the specific ACEs inventory items for children with 3 or more ACEs were listed.
Participant personal characteristics included child gender (girl, boy) and whether the child was US born (both from the questionnaire). Parent characteristics included the highest level of parental educational attainment (of either mother or father) in the categories 6 or fewer years versus 7 or more years (from the questionnaire); whether either parent was fluent in English (from the questionnaire); and whether the father was always present the since the child’s birth (from the life history calendar). Family characteristics included the total number of adults living in the family (from the questionnaire), with values 1, 2, 3 or more; whether the family had experienced a deportation (from the questionnaire); and the number of times the family moved residence since the child’s birth (from the life history calendar), with values of 0, 1, 2, 3 or more.
Statistical Analysis
We conducted bivariate analyses to compare child, parent, and family characteristics between rural farmworker and urban children. Chi-square tests or Fisher’s exact tests were used as appropriate. Similar bivariate analyses were conducted between children with and without ACEs. Finally, a multivariable logistic regression model was fit to identify factors that influence the presence of any ACE. Predictors included in the logistic regression analysis were limited to those (1) reflecting a difference between rural and urban child personal, parent, and family characteristics with a p-value of 0.2 or less; (2) reflecting an association with experiencing an ACE with a p-value of 0.2 or less; (3) that had a sufficient number of cases; and (4) that were not co-linear with other predictors. All analyses were performed using SAS 9.4 (Cary, NC). A p value of less than 0.05 was considered statistically significant.
Results
Child and Family Characteristics
Three of the 141 children recruited to PACE5 did not have a parent who was an immigrant and were excluded from this analysis. Of the 138 PACE5 Latinx children in immigrant families, 75 lived in rural communities and 63 lived in urban communities (Table 1). Rural and urban samples had similar gender distributions, with 48.0% and 52.4% girl and 52.0% and 47.6% boy participants for rural versus urban, respectively. An equivalent proportion of rural and urban participants were born in the US (89.3% rural and 95.2% urban). A smaller proportion of rural versus urban parents had completed seven or more years of education (67.7% versus 84.1%, p = 0.01). While the majority of parents were not fluent in English, fewer rural than urban parents could speak English (16.0% versus 33.3%, p = 0.01). A father was always present in the majority of families for both groups (77.5% rural and 76.7% urban). The number of total adults in the family differed between rural and urban families; a greater proportion of rural families had only a single adult (16.4% versus 6.2%), and a larger proportion of urban families had three or more adult members (20.6% versus 8.2%) (p = 0.03). Most families had never experienced a family member being deported (94.7% rural versus 90.5% urban). Rural families changed residence significantly less since the child’s birth, with 12.7% reporting 3 or more moves versus 45.0% of urban families reporting 3 or more moves (p <0.01).
Table 1.
Child, Parent, and Family Characteristics by Rural Farmworker versus Urban Non-Farmworker Status Among Latinx Children in Immigrant Families in North Carolina.
| Child, Parent, and Family Characteristics | All Participants N = 138 |
Rural Farmworker N = 75 |
Urban Non-Farmworker N = 63 |
p-value |
|---|---|---|---|---|
|
| ||||
| n (%) | n (%) | n (%) | ||
|
| ||||
| Child Characteristics | ||||
| Child Gender | 0.60 | |||
| Female | 69 (50.0) | 36 (48.0) | 33 (52.4) | |
| Male | 69 (50.0) | 39 (52.0) | 30 (47.6) | |
| Child US Born | 0.22 | |||
| No | 11 (8.0) | 8 (10.7) | 3 (4.8) | |
| Yes | 127 (92.0) | 67 (89.3) | 60 (95.2) | |
| Parent Characteristics | ||||
| Parent Educational Attainment | 0.01 | |||
| 6 years or less | 35 (25.4) | 25 (33.3) | 10 (15.9) | |
| 7 years or more | 103 (74.6) | 50 (67.7) | 53 (84.1) | |
| Parent Fluent in English | 0.01 | |||
| No | 105 (76.1) | 63 (84.0) | 42 (66.7) | |
| Yes | 33 (23.9) | 12 (16.0) | 21 (33.3) | |
| Father Always Present | 0.91 | |||
| No | 30 (22.9) | 16 (22.5) | 14 (23.3) | |
| Yes | 101 (77.1) | 55 (77.5) | 46 (76.7) | |
| Family Characteristics | ||||
| Number of Adults in Family | 0.03 | |||
| 1 | 16 (11.8) | 12 (16.4) | 4 (6.3) | |
| 2 | 101 (74.3) | 55 (75.3) | 46 (73.0) | |
| 3 or more | 19 (14.0) | 6 (8.2) | 13 (20.6) | |
| Deportation in Family | 0.51 | |||
| No | 128(92.8) | 71 (94.7) | 57 (90.5) | |
| Yes | 10 (7.2) | 4 (5.3) | 6 (9.5) | |
| Number of Residential Moves | <0.01 | |||
| 0 | 30 (22.9) | 21 (29.6) | 9 (15.0) | |
| 1 | 40 (30.5) | 28 (39.4) | 12 (20.0) | |
| 2 | 25 (19.1) | 13 (18.3) | 12 (20.0) | |
| 3 or more | 36 (27.5) | 9 (12.7) | 27 (45.0) | |
ACEs Scores
Mothers of almost half (47.1%) of the children reported no ACEs. Among mothers reporting at least one ACE, 47 (33.3%) reported 1 ACE, 12 (8.7%) reported 2 ACEs, and 16 (10.9%) reported 3 or more ACEs. A smaller proportion of rural than urban children experienced at least one ACE (46.7% versus 60.5%), but this difference was not statistically significant (p = 0.10) in this bivariate analysis (Table 2). Rural and urban children did differ significantly for several specific adverse experiences. Fewer rural than urban children experienced domestic violence (5.3% versus 15.9%, p = 0.05), neighborhood violence (1.3% versus 11.3%, p = 0.02), mental illness in the home (none versus 6.3%, p = 0.04), and substance abuse in the home (2.7% versus 11.1%, p = 0.07).
Table 2.
Frequency of Adverse Childhood Experience Items (ACEs) Among Latinx Children in Immigrant Families: Rural Farmworker Compared to Urban Non-farmworker in North Carolina.
| Total ACEs Score and Component Items | Rural, Farmworker n = 75 n (%) |
Urban, Non-Farmworker n = 63 n (%) |
p-value |
|---|---|---|---|
|
| |||
| Total ACEs Score | 0.10 | ||
| No ACEs | 40 (53.3) | 25 (39.7) | |
| One or more ACEs | 35 (46.7) | 38 (60.5) | |
| Component Items | |||
| Financial hardship | 29 (38.7) | 19 (30.2) | 0.29 |
| Parent divorced or separation | 11 (14.7) | 15 (23.8) | 0.17 |
| Parent death | 1 (1.3) | 1 (1.6) | 1.00 |
| Parent in jail a | 6 (8.0) | 7 (11.3) | 0.51 |
| Domestic violence | 4 (5.3) | 10 (15.9) | 0.05 |
| Neighborhood violence a | 1 (1.3) | 7 (11.3) | 0.02 |
| Mental health illness in home | 0 | 4 (6.3) | 0.04 |
| Substance abuse in home | 2 (2.7) | 7 (11.1) | 0.07 |
| Discrimination b | 1 (1.3) | 2 (3.3) | 0.51 |
One missing urban non-farmworker observation
Three missing urban non-farmworker observations
Factors Influencing ACEs
The children did not differ in ACEs by gender, parent educational attainment, parent fluent in English, deportation of a family member, or number of residential moves (Table 3). Children who were born outside of the US had an ACE more often than those born in the US (90.9% vs 49.6%, p = 0.01). Children who did not always have their fathers present in the home had an ACE more often than those whose fathers were always present (90.0% vs 40.6%, p < 0.01). Additionally, 87.5% of children with only one adult in the family experienced an ACE compared to 46.5% with 2 adults and 57.9% with 3 or more adults in the family (p < 0.01).
Table 3.
Differences in the Experience of at Least One ACE by Child and Family Characteristics Among Latinx Children in Immigrant Families in North Carolina.
| Child and Family Characteristics | No ACEs N=65 |
One or More ACEs N=73 |
p-value |
|---|---|---|---|
|
| |||
| n (%) | n (%) | ||
|
| |||
| Child Characteristics | |||
| Child Gender | 0.49 | ||
| Female | 30 (43.5) | 39 (56.5) | |
| Male | 35 (50.7) | 34 (49.3) | |
| Child US Born | 0.01 | ||
| No | 1 (9.1) | 10 (90.9) | |
| Yes | 64 (50.4) | 63 (49.6) | |
| Parent Characteristics | |||
| Parent Educational Attainment | 0.56 | ||
| 6 years or less | 15 (42.9) | 20 (57.1) | |
| 7 years or more | 50 (48.5) | 53 (51.5) | |
| Parent Fluent in English | 0.85 | ||
| No | 49 (46.7) | 56 (53.3) | |
| Yes | 16 (48.5) | 17 (51.5) | |
| Father always present | <0.01 | ||
| No | 3 (10.0) | 27 (90.0) | |
| Yes | 60 (59.4) | 42 (40.6) | |
| Family Characteristics | |||
| Number of adults in Family | <0.01 | ||
| 1 | 2 (12.5) | 14 (87.5) | |
| 2 | 54 (53.5) | 47 (46.5) | |
| 3 or more | 8 (42.1) | 11 (57.9) | |
| Deportation in Family | 0.10 | ||
| No | 63 (49.2) | 65 (50.8) | |
| Yes | 2 (20.0) | 8 (80.0) | |
| Number of Residential Moves | 0.31 | ||
| 0 | 19 (63.3) | 11 (36.7) | |
| 1 | 17 (42.5) | 23 (57.5) | |
| 2 | 11 (44.0) | 14 (56.0) | |
| 3 or more | 16 (44.4) | 20 (55.6) | |
Three of the items in the ACEs inventory, parental divorce or separation, parent in jail, and parental death, may be caused by or reflect the two family characteristics one adult in family and deportation in family. Therefore, a reviewer requested that the specific items in the ACEs inventory be reported for participants with at least one ACE and who experienced one adult in their family or experienced a deportation in their family. Eleven children had one adult in their family, 5 children experienced a deportation in their family, and 3 children experienced both one adult and a deportation in their family.
For the 11 children with one adult in their family and who experienced one or more ACEs, 9 experienced financial hardship, 4 experienced parents being divorced or separated, 1 experienced a parent death, 5 experienced a parent in jail, 2 experienced domestic violence, 1 experienced neighborhood violence, none experienced mental health illness in the home, 1 experienced substance abuse in the home, and 1 experienced discrimination. For the 5 children with a deportation in their family and who experienced one or more ACEs, 4 experienced financial hardship, 4 experienced parents being divorced or separated, none experienced a parent death, 1 experienced a parent in jail, 4 experienced domestic violence, 4 experienced neighborhood violence, 2 experienced mental health illness in the home, 4 experienced substance abuse in the home, and none experienced discrimination. For the 3 children experienced both one adult and a deportation in their family, and who experienced one or more ACEs, 1 experienced financial hardship, 1 experienced parents being divorced or separated, none experienced a parent death, 2 experienced a parent in jail, none experienced domestic violence, none experienced neighborhood violence, none experienced mental health illness in the home, 2 experienced substance abuse in the home, and none experienced discrimination.
The logistic regression model (Table 4) showed that urban children had over two times the odds of experiencing an ACE than did rural children (Odds Ratio (OR) = 2.35; 95% CI = 1.01, 5.48). In addition, children living in a family with 2 adults versus 1 adult had a lower odds of reporting an ACE (OR = 0.10, 95% CI = 0.02, 0.49). Children living in a family with 3 or more adults versus 1 adult also have a lesser odds of reporting an ACE (OR = 0.12, 95% CI = 0.02, 0.78).
Table 4.
Logistic Regression Results of Factors Associated with Reporting One or More ACEs Among Latinx Children in Immigrant Families in North Carolina (N=138).
| Predictors | Odds Ratio (95% Confidence Interval) |
p-value |
|---|---|---|
|
| ||
| Urban versus Rural | 2.35 (1.01, 5.48) | 0.04 |
| Parents’ Educational Attainment | ||
| 7–12 versus 0–6 | 0.92 (0.37, 2.30) | 0.86 |
| Parent Fluent in English | 0.88 (0.36, 2.19) | 0.78 |
| Number of Residential Moves | ||
| 1 versus 0 | 2.36 (0.82, 6.82) | 0.11 |
| 2 versus 0 | 2.18 (0.67, 7.06) | 0.19 |
| 3or more versus 0 | 1.72 (0.56, 5.30) | 0.34 |
| Adults in Family | ||
| 2 versus 1 | 0.10 (0.02, 0.49) | <0.01 |
| 3 or more versus 1 | 0.126 (0.02, 0.78) | 0.02 |
Children Experiencing 3 or More ACEs
Sixteen children experienced 3 or more ACEs, 6 from rural communities and 10 from urban communities (Table 5). Specific adverse experiences are common for the children who experienced three or more ACEs. Among the rural children, 5 of the 11 children who experienced a parental divorce or separation were in the 3 or more ACEs group. Five of the 6 rural children with a parent in jail were in the 3 or more ACEs group, as were all four of those who experienced domestic violence and both of those who experienced substance abuse in the home. Among the urban children, 8 of the 16 children experiencing a parental divorce or separation were in the 3 or more ACEs group. Four of the 7 urban children with a parent in jail were in the 3 or more ACEs group, as were as 7 of the 11 reporting domestic violence, 4 of the 7 who experienced neighborhood violence, 3 of the 4 who experienced mental illness in the home, and 7 of the 8 who experienced substance abuse in the home. Across all of these Latinx immigrant children, it appears that having a parent in jail, domestic violence, and substance abuse in the home are indicators of 3 or more ACEs.
Table 5.
Adverse Experiences of Children with Three or More Adverse Childhood Experiences, Latinx Children in Immigrant Families in North Carolina.
| Participant | Financial Hardship | Parent Divorce or Separation | Parent Death | Parent in Jail | Domestic Violence | Neighborhood Violence | Mental Health Illness in Home | Substance Abuse in Home | Discrimination | Total ACEs |
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| Rural Farmworker Children | ||||||||||
|
| ||||||||||
| 1 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 3 |
| 2 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 3 |
| 3 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 3 |
| 4 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 3 |
| 5 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 4 |
| 6 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 3 |
| Total = 6/76a | 3/29b | 5/11 | 0 | 5/6 | 4/4 | 0 | 0 | 2/2 | 0 | |
|
| ||||||||||
| Urban Non-farmworker Children | ||||||||||
|
| ||||||||||
| 1 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 3 |
| 2 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 4 |
| 3 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 0 | 5 |
| 4 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 3 |
| 5 | 1 | 0 | 0 | 1 | 0 | -c | 0 | 1 | -c | 3 |
| 6 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 3 |
| 7 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 6 |
| 8 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 6 |
| 9 | 0 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 5 |
| Total =10/65 | 6/20 | 7/16 | 0 | 4/7 | 7/11 | 4/7 | 3/4 | 6/8 | 1/2 | |
Number of children with 3 or more ACEs, over the number of children in the entire group (rural farmworker and urban non-farmworker).
Number of children in the 3 or more ACEs group with this experience, over the number of children in the entire group (rural, farmworker and urban, non-farmworker) with this experience. For example, among the rural farmworkers, 3 children with high ACEs had financial hardship, while 29 of all 76 rural farmworker children experienced financial hardship; among the rural farmworkers, 4 children with 3 or more ACEs experienced domestic violence, and these were all of the rural farmworker children who experienced domestic violence.
Missing.
Discussion
ACEs have been linked to immediate and life-long health problems. Children in Latinx immigrant families might be expected to experience multiple ACEs due to their exposure to poverty, environmental exposures, and discrimination. Over half of the eight-year old Latinx children in low-income immigrant families who participated in PACE5 experienced one or more ACEs, with over 10% experiencing three or more ACEs. This level of ACEs is similar to that reported for low-income immigrant Latinx children in national surveys [3], and it is marginally lower than that reported for adults in the general North Carolina population [5, 23].
A major factor associated with the prevalence of ACEs among the Latinx immigrant children who participated in this study is locality. Those who lived in urban communities had over twice the odds of experiencing one or more ACEs than those who lived in rural communities. Significantly more of the urban children reported specific adverse experiences, including domestic violence, neighborhood violence, mental illness at home, and substance abuse at home. This may reflect family chaos [24,25] in the urban environment; more of the urban families than the rural families in this study also had three or more adults living in their families and changed their residences more frequently. Research on the importance of locality in ACEs prevalence for the general US population presents mixed results. Some indicates rural areas are at increased risk for ACEs because these communities have higher rates of poverty and a larger minority population [17, 26]. Others report that urban populations exhibit higher ACEs prevalence than rural settings [15]. Little research has considered urban-rural residence as a factor in the prevalence of ACEs among Latinx immigrant children. A study that focused on ACEs among Latinx adults living in a rural area of California [16] found that these adults had a lower prevalence (40%) of ACEs than the adult US population. Future research should consider the importance of locality in determining ACEs prevalence among immigrant Latinx children.
Being in a family with one adult versus two or more adults is the only other factor to maintain a significant association with ACEs prevalence in the logistic regression analysis. Being in a single parent family is reported by others to be commonly associated with ACEs [3, 15], with Wade et al. [14] reporting that single parent families are stressful for children. Future research should delineate whether having a single parent increases ACEs, or whether the events leading to having a single parent (parental divorce, parent in jail, domestic violence) increase ACEs. This could not be examined in the current study.
Future research examining ACEs prevalence among Latinx immigrant children should consider specific adverse experiences. Having a parent in jail, domestic and neighborhood violence, and mental illness and substance abuse were factors that differentiate those with three or more ACEs from those reporting fewer ACEs. Another important factor associated with ACEs prevalence is the family experiencing a deportation. Eight of the 10 children whose family experience a deportation reported one or more ACEs. The small number of families with deportations limited the inclusion of this factor in the logistic regression analysis. However, given the ongoing controversy in the US surrounding immigration and deportation, and the high levels of deportation during the Obama and Trump administrations, the experience of deportation should be considered in future ACEs research among immigrant Latinx children and adults.
Loria and Caughy [3] provide a data to compare the ACEs experienced by the PACE5 participants with national data (Table 6). Loria and Caughy [3] use the same inventory for measuring ACEs as PACE5. Their national sample is limited to families with incomes below 200% of the Federal Poverty Level. They also report ACEs prevalence by immigration generation, with their second generation most similar to the PACE5 children who were largely (92.2%) born in the US with immigrant parents. The Loria and Caughy children were similar to the PACE5 children in overall ACE prevalence; about half report no ACEs, one-third report 1 ACE, about one-tenth report 2 ACEs, and about one-tenth report 3 or more ACEs. The children in the two studies appear to differ in the prevalence of specific components of the scale. More of the PACE5 children than the Loria and Caughy children experienced parental divorce or separation (18.8% versus 12%), a parent in jail (9.5% versus 4%), and domestic violence (10.1% versus 5%).
Table 6.
Comparison of ACEs Reported for Study Participants with Results of a Loria and Caughy’s [3] National Survey of Low-Income Latinx Immigrant ACEs.
| Total ACEs Score and Component Items | PACE5 N=138 % |
Loria & Caughy [3] 2nd Generation % |
|---|---|---|
|
| ||
| Total ACEs Score | ||
| No ACEs | 47.1 | 50 |
| One ACE | 33.3 | 33 |
| Two ACEs | 8.7 | 10 |
| Three or more ACEs | 10.9 | 7 |
| Component Items | ||
| Financial hardship | 34.8 | 36 |
| Parent divorced or separation | 18.8 | 12 |
| Parent death | 1.4 | 2 |
| Parent in jail | 9.5 | 4 |
| Domestic violence | 10.1 | 5 |
| Neighborhood violence | 5.8 | 7 |
| Mental health illness in home | 2.9 | 5 |
| Substance abuse in home | 6.5 | 7 |
| Discrimination | 2.2 | 4 |
This study used a standard inventory to measure ACEs [3, 9]. However, several investigators have cited the impact of important features of the immigrant Latinx population that may contribute to ACEs [1, 9, 11, 12, 14]. Some have suggested that ACE items be expanded to capture features related to low-income settings [14] and Latinx communities [9, 12]. Wade et al. [14] surveyed low-income children in Philadelphia and identified a list of additional experiences that should be included to examine ACEs among children in high poverty communities, including peer relationships, and media or tech related harassment. LaBrenz et al. [9] compared differences between traditional, expanded and full ACE questionnaires in efforts to capture Latinx experiences. The Latinx community faces adversities in addition to such general risk factors as poverty, food insecurity, and reduced access to healthcare [1, 3, 9, 10, 12, 19]. These additional risk factors include greater incidence of discrimination [1, 9, 11], parental incarceration [9], trauma related to immigration, threat of deportation [12], and stressful immigration policies [1].
Strengths of this analysis were its use of a standard inventory to measure ACEs and being part of a long-term community-engaged research program that has established trust among study participants. However, its results should be evaluated in light of the study’s limitations. Participants were not randomly selected, and were recruited from limited locales in North Carolina. These features limit the study’s generalizability. The sample was limited to children in families with incomes below 200% of the poverty level, and all children were only 8 years old. Care should be taken comparing these findings to studies without these limitations. The sample size limited the inclusion of interesting characteristics (e.g., family deportation) in the multivariate analysis. Reporting bias may have also affected the results; the parents might not have been aware of experiences outside the home, such as discrimination in communities or schools, and may not have reported all of the experiences of which they were aware. Social desirability was another concern; the mothers’ vulnerable status as immigrants may have led them to under-report negative responses. Social desirability may account for the small number of mothers, particularly rural mothers, who reported the ACE “mental health illness in home.”
Conclusions
This study highlights the prevalence of ACEs among immigrant Latinx children living in rural and urban communities. Total ACEs prevalence for these children is similar to that reported for other immigrant Latinx children, but with some differences in specific adverse experiences. These results show differences in ACEs prevalence and specific adverse experiences between rural and urban children. Although not included in the multivariate analysis, the results hint at the importance of family deportation in the prevalence of ACEs. These results argue for more and detailed research on ACEs prevalence among immigrant Latinx children and adults based on locality.
This research did not collect information on adverse health effects of the ACEs reported for these children. Further analysis of the PACE5 data, as well as future research, must consider such health consequences. Future culturally tailored ACEs studies need to capture how Latinx youth express their health concerns. Integrating these insights into prevention and interventions oriented towards Latinx youth may reduce ACEs among this population and mitigate health risks. Data on childhood adversity and its effect on health may also provide awareness for funding immigrant health services, promoting Latinx immigrant communities’ needs, and prioritizing immigrant rights [12]. Policy should address the need for further understanding the role of ACEs in health services among Latinx.
Acknowledgment:
The authors appreciate the support of their community partners, the North Carolina Farmworkers Project and of Student Action with Farmworkers, and appreciate the valuable contributions of our community field interviewers in carrying out participant recruitment and data collection. They especially thank the children and parents who participated in this study.
Funding: This research was funded by the National Institute of Environmental Health Sciences [grant number R01 ES08739]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Footnotes
Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.
Contributor Information
Dorothy L. Dobbins, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC.
Lesley M Berenson, Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Haiying Chen, Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
Sara A. Quandt, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
Paul J. Laurienti, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC.
Thomas A. Arcury, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem NC.
References
- 1.Caballero TM, Johnson SB, Buchanan CRM, DeCamp LR: Adverse childhood experiences among Hispanic children in immigrant families versus US-native families. Pediatrics. 2017;140(5):e20170297. doi: 10.1542/peds.2017-0297. [DOI] [PubMed] [Google Scholar]
- 2.Centers for Disease Control and Prevention. Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2019. Available from https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf [accessed 11 February 2021]. [Google Scholar]
- 3.Loria H, Caughy M: Prevalence of adverse childhood experiences in low-income Latino immigrant and nonimmigrant children. J Pediatrics. 2018;192:209–15.e1. doi: 10.1016/j.jpeds.2017.09.056. [DOI] [PubMed] [Google Scholar]
- 4.Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. : Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–58. doi: 10.1016/s0749-3797(98)00017-8. [DOI] [PubMed] [Google Scholar]
- 5.Hege A, Bouldin E, Roy M, Bennett M, Attaway P, Reed-Ashcraft K: Adverse childhood experiences among adults in North Carolina, USA: Influences on risk factors for poor health across the lifespan and intergenerational implications. Int J Environ Res Pu. 2020;17(22):8548. doi: 10.3390/ijerph17228548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Solberg MA, Peters RM: Adverse childhood experiences in non-Westernized nations: Implications for immigrant and refugee health. J Immigr Minor Health. 2020;22(1):145–55. doi: 10.1007/s10903-019-00953-y. [DOI] [PubMed] [Google Scholar]
- 7.Maternal Child Health Bureau HRSA, National Survey of Child Health (NSCH): Adverse Childhood Experiences: NSCH Data Brief, June 2020. Available from https://mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/nsch-ace-databrief.pdf [accessed 27 January 2021].
- 8.Crouch E, Radcliff E, Merrell MA, Bennett KJ. Rural-urban differences in positive childhood experiences across a national sample. J Rural Health. 2021;37(3):495–503. doi: 10.1111/jrh.12493. [DOI] [PubMed] [Google Scholar]
- 9.LaBrenz CA, Panisch LS, Lawson J, Borcyk AL, Gerlach B, Tennant PS, et al. : Adverse childhood experiences and outcomes among at-risk Spanish-speaking Latino families. J Child Fam Stud. 2020;29(5):1221–35. doi: 10.1007/s10826-019-01589-0. [DOI] [Google Scholar]
- 10.Slopen N, Shonkoff JP, Albert MA, Yoshikawa H, Jacobs A, Stoltz R, et al. : Racial disparities in child adversity in the U.S. interactions with family immigration history and income. Am J Prev Med. 2016;50(1):47–56. doi: 10.1016/j.amepre.2015.06.013. [DOI] [PubMed] [Google Scholar]
- 11.Vaughn MG, Salas-Wright CP, Huang J, Qian Z, Terzis LD, Helton JJ: Adverse childhood experiences among immigrants to the United States. J Interpers Violence. 2017;32(10):1543–64. Epub 2015/06/27. doi: 10.1177/0886260515589568. [DOI] [PubMed] [Google Scholar]
- 12.Zetino YL, Galicia BE, Venta A: Adverse childhood experiences, resilience, and emotional problems in Latinx immigrant youth. Psychiat Res. 2020;293:113450. doi: 10.1016/j.psychres.2020.113450. [DOI] [PubMed] [Google Scholar]
- 13.Sacks V, Murphey D, Moore K: Adverse Childhood Experiences: National and State-Level Prevalence. Child Trends #2014–28; 2014. Available from https://www.childtrends.org/publications/adverse-childhood-experiences-national-and-state-level-prevalence [accessed 11 February 2021].
- 14.Wade R Jr., Shea JA, Rubin D, Wood J: Adverse childhood experiences of low-income urban youth. Pediatrics. 2014;134(1):e13–20. doi: 10.1542/peds.2013-2475. [DOI] [PubMed] [Google Scholar]
- 15.Chanlongbutra A, Singh GK, Mueller CD: Adverse childhood experiences, health-related quality of life, and chronic disease risks in rural areas of the United States. J Environ Res Public Heal. 2018;2018:7151297. doi: 10.1155/2018/7151297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Barrera I, Sharma V, Aratani Y: The prevalence of mental illness and substance abuse among rural Latino adults with multiple adverse childhood experiences in California. J Immigr Minor Health. 2019;21(5):971–6. doi: 10.1007/s10903-018-0811-9. [DOI] [PubMed] [Google Scholar]
- 17.Arcury TA, Quandt SA: Community-based participatory research and occupational health disparities: Pesticide exposure among immigrant farmworkers. In: Leong FTL, Eggerth DE, Chang DH, Flynn MA, Ford JK, Martinez RO, editors. Occupational Health Disparities: Improving the Well-Being of Ethnic and Racial Minority Workers. Washington, DC: APA Press; 2017. p. 89–112. [Google Scholar]
- 18.Stein LJ, Gunier RB, Harley K, Kogut K, Bradman A, Eskenazi B. Early childhood adversity potentiates the adverse association between prenatal organophosphate pesticide exposure and child IQ: The CHAMACOS cohort. Neurotoxicology. 2016;56:180–187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Quandt SA, Mora DC, Seering TL, Chen H, Arcury TA, Laurienti PJ: Using life history calendars to estimate in utero and early life pesticide exposure of Latinx children in farmworker families. Int J Environ Res Pu. 2020;17(10). doi: 10.3390/ijerph17103478. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.2011/12 National Survey of Children’s Health. Child and Adolescent Health Measurement Initiative (CAHMI), “2011– 2012 NSCH: Child Health Indicator and Subgroups SAS Codebook, Version 1.0” 2013, Data Resource Center for Child and Adolescent Health, sponsored by the Maternal and Child Health Bureau. www.childhealthdata.org.Availablefromhttps://www.childhealthdata.org/docs/nsch-docs/sas-codebook_−2011-2012-nsch-v1_05-10-13.pdf [accessed 11 February 2021] [Google Scholar]
- 21.Arcury TA NH, Summers P, Talton JW, Holbrook LC, Walker FO, Chen H, Howard TD, Galván L, Quandt SA: Lifetime and current pesticide exposure among Latino farmworkers in comparison to other Latino immigrants. Am J Ind Med. 2014;57(7):776–87. doi: 10.1002/ajim.22324. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Austin A, Herrick H, Ed M. The effect of adverse childhood experiences on adult health: 2012 North Carolina behavioral risk factor surveillance system survey: SCHS Studies. 2014;167:1–15. [Google Scholar]
- 24.Vernon-Feagans L, Garrett-Peters P, De Marco A, Bratsch-Hines M: Children living in rural poverty: The role of chaos in early development. In: KR VM,B, editors. The Oxford handbook of poverty and child development Oxford: Oxford University Press; 2012. p. 448–66. [Google Scholar]
- 25.Quandt SA, Arnold TJ, Mora DC, Arcury A, Talton JW, Daniel SS: Hired Latinx child farmworkers in North Carolina: educational status and experience through a social justice lens. New Solut. 2021. Feb;30(4):282–293. doi: 10.1177/1048291120970207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Crouch E, Radcliff E, Probst JC, Bennett KJ, McKinney SH: Rural-urban differences in adverse childhood experiences across a national sample of children. J Rural Health. 2020;36(1):55–64. doi: 10.1111/jrh.12366. [DOI] [PubMed] [Google Scholar]