Parent-child nativity, race, ethnicity, and adverse childhood experiences among U.S. children

Abstract

We examined the relationship between parent-child nativity, race/ethnicity, and adverse childhood experiences (ACEs) among U.S. children. We found that a high proportion of Black/Hispanic children experienced ACEs, with variation by generation for Hispanic but not Black children, while a lower but increasing proportion of White children experienced ACEs by generation.

INTRODUCTION

Adverse childhood experiences (ACEs) are defined as traumatic experiences in a person’s life during childhood. An estimated one in three children have at least one ACE in the United States (U.S.) Previous studies have examined the impact of self-reported ACEs including childhood abuse, neglect, and household challenges or dysfunction such as parental separation or incarceration, family mental illness, and other factors such as poverty, community violence, and homelessness.¹ These studies have shown that ACEs are associated with short- and long-term health problems, including high blood pressure,² cardiovascular disease,^1–3 and higher overall mortality rates^4,5, as well as different neurodevelopmental and behavioral health conditions, including learning disability,^6,7 anxiety,^7–11 substance use disorders,^1,7,9–16 depression,^{2,7,9–11,17} post-traumatic stress disorder (PTSD),^18,19 high-risk sexual behavior,^1,20 and suicide attempts.^5,21,22

There is significant interest in the study of ACE disparities, including whether racial and ethnic minorities disproportionately experience more ACEs and higher levels of toxic stress compared to other populations. Multiple previous studies have demonstrated significant racial, ethnic, and socioeconomic disparities of childhood adversity in the U.S.^23–25. For instance, previous analyses have found that in the U.S., children of different races and ethnicities do not experience ACEs equally, and prevalence estimates of Black non-Hispanic children and Hispanic children with at least one ACE are significantly higher than those of White non-Hispanic children and Asian non-Hispanic children.²³ However, there is paradoxical evidence regarding the impact of immigrant generation on ACE disparities. For instance, previous studies have reported that Latinx immigrants report lower ACEs compared to nonimmigrant children despite the different disparities that ethnic minorities face in the U.S.^26,27 Additionally, patterns of racial/ethnic disparities and income differences have been observed for most individual adversities among non-immigrant households (i.e., U.S.-born households), but are not as common or consistent among children of immigrant parents. In some respects, these findings are consistent with the “healthy immigrant paradox” – that immigrant groups settling in the host countries display health advantages compared to native-born populations²⁸, although it’s unclear if differences in ACEs represent a health advantage. Related to this phenomenon are other “paradoxes”, for instance, that the children of immigrants have higher educational attainment than children of native-born Americans.²⁹

Race, ethnicity, and nativity together can also serve as a proxy for the confluence of migration-related stressors, discrimination, acculturation, household challenges, and socioeconomic adversities faced that have the potential to adversely impact a person’s physical, emotional, psychological, and neurodevelopmental health. We sought to understand the relationships between parent-child nativity (used interchangeably with household generation), race, ethnicity, and childhood adversity among U.S. children. The current study examines associations between parent-reported ACEs not specifically related to child abuse and neglect—also known as household challenge ACEs—and nativity, race, and ethnicity using the most up-to-date, nationally representative data available through the National Survey of Children’s Health (NSCH). We hypothesized that there are significant racial and ethnic disparities of experiencing ACEs, with non-White racial and ethnic minority children disproportionately experiencing ACEs – and potentially higher number of ACEs – compared to White children across different household generations.

METHODOLOGY

Study Population

The NSCH is a leading national survey on children’s health in the U.S., sponsored by the Maternal and Child Health Bureau. It used a multi-stage sampling approach to identify households with children, and oversampled children 0–5 years old and children with special health care needs (such as learning, speech, and intellectual disabilities).³⁰ The National Center for Health Statistics Research Ethics Review Board approved all data collection procedures for the survey. In the present study, we analyzed data from the most recent 2016, 2017, 2018, and 2019 NSCH, consisting of 131,774 respondents. The overall weighted response rate of the NSCH questionnaire was 40.7%, 37.4%, 43.1%, and 42.4% for 2016, 2017, 2018, and 2019 respectively. The present study is a secondary analysis on anonymous data and is therefore exempted from IRB review.

The respondents to the NSCH survey are parents or guardians or an adult in a civilian, non-institutional household who is most familiar with the child’s health and healthcare. Households were invited to complete a short screening questionnaire that asked participants to identify all children aged 0–17 years living in the household. If a child lived in the household, the participants were directed to a more detailed, age-specific topical questionnaire. Only one child per household was randomly selected to be the subject of the detailed topical questionnaire.

Measures

As part of the survey, parents of sampled children reported whether parents and/or children were born in the U.S. Responses were used to define household generation as follows: first-generation = both parents and child born outside the U.S.; second-generation = one parent born outside the U.S. and the child born in the U.S.; third- and higher generation = both parents and child born in the U.S.

Parents also responded to nine ACE questions about household challenges (Table 1, online), also referred to as “household dysfunction”, some of which are the original ACE questions used in the seminal study for this topic.¹ These questions included whether the child had ever experienced parental/guardian divorce, separation or death, had an incarcerated parent or guardian, witnessed parents or other adults physically abusing one another in the home, or lived with anyone who was mentally ill, suicidal, severely depressed or had a drug/alcohol problem (with responses being “yes” or “no”). One of the ACE questions asked how often, since the child’s birth, it has been difficult to cover basic needs such as food or housing on the family’s income, with responses being “never”, “rarely”, “somewhat often” or “very often” (“never” and “rarely” were recoded as “no”, and “somewhat often” and “very often” were recoded “yes”). Responses were used to determine if children experienced any ACEs (0 vs. 1+) and determine a modified ACE count outcome of 0, 1, 2, and 3 or more ACEs The binary outcome was created for the purpose of using a logistic regression model to quantify risk, as well as aligning one analysis with a common practice of reporting ACEs by the prevalence of people who have at least one ACE.^31–33 For the modified ACE count outcome, ACE counts of 3 or more were collapsed into one category since there were only a relatively small number of respondents with 4 or higher reported ACEs⁷, especially given additional stratifications that would be performed by race, ethnicity, and household generation.

Table 1:

Questions about adverse childhood experiences (ACEs) from the National Survey of Child Health used for the analysis in this study.

Adverse Childhood Experiences (ACE) Questions To the best of your knowledge, has this child EVER experienced any of the following? Parent or guardian divorced or separated 1 = Yes 2 = No Parent or guardian died 1 = Yes 2 = No Parent or guardian served time in jail 1 = Yes 2 = No Saw or heard parents or adults slap, hit, kick, punch one another in the home 1 = Yes 2 = No Was a victim of violence or witnessed violence in his or her neighborhood 1 = Yes 2 = No Lived with anyone who was mentally ill, suicidal, or severely depressed 1 = Yes 2 = No Lived with anyone who had a problem with alcohol or drugs 1 = Yes 2 = No Treated or judged unfairly because of his or her race or ethnic group 1 = Yes 2 = No Since this child was born, how often has it been very hard to cover the basics, like food or housing, on your family’s income? 1 = Never 2 = Rarely 3 = Somewhat often 4 = Very often

Information on the child’s age, sex, race/ethnicity, and family income as well as parental educational attainment was collected. Race/ethnicity information was used to create the following categories: “Asian (non-Hispanic)”, “Black (non-Hispanic)”, “Hispanic”, “White (non-Hispanic)”, and “Other (non-Hispanic)”. Family income levels were classified based on the ratio of family income to poverty guidelines specific to the survey year as <1.0, 1.0–1.9, 2.0–3.9, and ≥4.0. Parent highest level of education was classified as “Less than high school”, “High school (including vocational, trade, or business school)”, “Some college or associate degree,” and “College degree or higher.”

Statistical Analyses

Since the data for this study were collected using a survey design with complex sampling, the multiple imputation approach and all subsequent statistical analyses incorporated the survey design including the survey weights (which account for oversampling), strata, and primary sampling units. We used weighted multivariable logistic regression to examine the associations between household generation and ACEs stratified by race/ethnicity (Asian, Black, Hispanic, White), and between race/ethnicity and ACEs stratified by household generation, adjusting for demographics (age, sex, family income to poverty ratio, and parental education). We also ran multinomial logit models to examine the effects of higher number of ACEs with an ACE count outcome of 0, 1, 2, and 3+ ACEs. Sample size limitations for higher number of ACEs (4 or more ACE groups alone) required us to combine the category of three or more ACEs given the need to further stratify groups by race, ethnicity, and household generation. Models were fit for each of the 30 multiply imputed data sets, and predicted marginal proportions (model-adjusted risks)³⁴ for ACEs were calculated using multiple imputation methods implemented in SUDAAN and incorporating the survey design and subpopulation analysis methods for analyses that used of a subset of the public use data. P<0.05 was considered statistically significant.

Multiple imputation was used to handle missing data in the NSCH. Multiple imputation was performed using fully conditional specification methods implemented in SAS® software version 9.4 (SAS Institute: Cary, NC), and for this imputation, we decided to impute missing values separately within each year of data which reflects how income was imputed for the public use data sets. The variables used in the multiple imputation procedure included the sample design variables, NSCH ACE questions, nativity questions, and the parental marital status, parental education, race, ethnicity, sex, and other variables used in the subsequent statistical models. For the family income to poverty ratio variable, each year has six imputed values. All six of those values were used for each of the four years, with an additional five imputed datasets created per value. This approach yielded 30 imputed datasets used for model fitting. Models were fit and parameter estimates were summarized using multiple imputation methods implemented in SUDAAN Release 11.0.3 (Research Triangle Institute: Research Triangle Park, NC).

The nativity/household generation variable is based on several variables: whether the child was born in the U.S., whether each parent was born in the U.S., and two more variables that name the relationship of the adult living with the child. If a child was not living with any parent (biological, adoptive, foster or step), then they could not be classified into first-, second-, or third- and higher generation, even after our imputation procedure. These respondents (n = 5,226; 5.85%) were still included in the analysis data set since they were included in the imputation procedure.

RESULTS

The presence of ACEs varies across different groups defined by household generation, race, and ethnicity. Distributions of demographics and study variables among U.S. children in the NSCH are provided in Table 2 (online). The prevalence of experiencing ACEs by demographics and household generation is provided in Table 3. The prevalence of experiencing ACEs was 39.6%, 34.8%, and 43.5% in first-, second-, and third- and higher generation children, respectively. The prevalence estimates of 0, 1, 2, and 3+ ACEs among U.S. children were 56.8%, 22.9%, 9.2%, and 11.1% respectively. The prevalence of experiencing ACEs was 23.5%, 58.8%, 46.5%, 38.5%, and 49.5% in Asian, Black/African American, Hispanic, White, and Other children respectively. Figure 1 illustrates the predicted marginal proportions of having ACEs stratified by household generation and race/ethnicity.

Table 2.

Distributions of demographics and study variables among U.S. children in the National Survey of Child Health 2016–2019 (n = 131,774).

Variable	Mean (SD)	Unweighted N	Weighted %
Age (years)	8.63 (0.03)	-----	-----
Family Poverty Ratio	246.50 (0.90)	-----	-----
Sex
Male		68095	51.11
Female		63679	48.89
Race/Ethnicity
Asian		6682	4.63
Black/African American		8110	13.18
Hispanic		15165	25.17
White		91666	50.83
Other		10151	6.20
Highest level of education
Less than high school		3096	9.28
High school (including vocational, trade, or business school)		16827	19.37
Some college or associate degree		30547	22.18
College degree or higher		81303	49.17
Household generation
1st generation		2190	2.82
2nd generation		20269	23.75
3rd generation		104090	67.59
Child born in the U.S. (unknown for parents)		5111	5.69
Child born outside the U.S. (unknown for parents)		115	0.16
Adverse Childhood Experiences (ACEs)
0		79090	56.84
1		28212	22.88
2		11288	9.17
3+		13184	11.12

Table 3.

Prevalence of adverse childhood experiences (ACEs) by demographics and household generation.

Variable	Mean (SD)	1+ ACEs
Age	9.8 (0.05)	-----
Family Poverty Ratio	203.6 (1.24)	-----
Sex
Male		43.1
Female		43.3
Race/Ethnicity
Asian		23.5
Black/African American		58.8
Hispanic		46.5
White		38.5
Other		49.5
Highest level of education
Less than high school		49.9
High school (including vocational, trade, or business school)		57.7
Some college or associate degree		55.2
College degree or higher		30.7
Household generation
1st generation		39.6
2nd generation		34.8
3rd generation		43.5
Child born in the U.S. (unknown for parents)		74.8
Child born outside the U.S. (unknown for parents)		74.2

Figure 1:

Variations in estimated prevalence of Adverse Childhood Experiences (ACEs) by household generation, race, and ethnicity. Sample-weighted predicted marginal proportions (model-adjusted risks) of adverse childhood experiences (ACEs) in racial/ethnic groups, stratified by household generation; predicted marginal proportions control for age, sex, family income to poverty ratio, and parental education (see models referred to in Table 4).

Certain race/ethnicity comparisons within household generation categories showed significant associations with the presence of ACEs. Bivariate associations of the year of the survey and household generation were not significant (chi-square p-value = 0.33). The associations between the prevalence of experiencing ACEs, household generation, and race/ethnicity are provided in Table 4 (online). Among first-generation children, Black (AOR=3.90, 95%CI=2.02–7.53) and Hispanic (AOR=2.52, 95%CI=1.40–4.57) children had higher odds of having ACEs vs. White children. These associations remained significant among second-generation children, although weaker (Black: AOR=1.61, 95%CI=1.25–2.06; Hispanic: AOR=1.25, 95%CI=1.04–1.51), as well as third- and higher generation children (Black: AOR=1.55, 95%CI=1.39–1.72; Hispanic: AOR=1.39, 95%CI=1.24–1.56). Second-generation Asian children had lower odds of having ACEs (AOR=0.72, 95%CI=0.58–0.88) vs. second-generation White children. Children belonging to the “Other” race/ethnicity category had higher odds of having ACEs among second generation (AOR=1.41, 95%CI=1.14–1.76) and third- and higher generation children (AOR=1.81, 95%CI=1.64–2.01).

Table 4.

Logistic regression associations between prevalence of adverse childhood experiences (1+ ACEs), household generation, and race/ethnicity.

Variable	1+ ACEs 1st Generation – AOR (95% CI)	1+ ACEs 2nd Generation – AOR (95% CI)	1+ ACEs 3rd+ Generation – AOR (95% CI)	1+ ACEs Asian – AOR (95% CI)	1+ ACEs Black – AOR (95% CI)	1+ ACEs Hispanic – AOR (95% CI)	1+ ACEs White – AOR (95% CI)	1+ ACEs Other – AOR (95% CI)
Sex (Reference: Male)
Female	1.24 (0.83–1.84)	1.01 (0.87–1.17)	1.00 (0.95–1.06)	1.07 (0.82–1.39)	1.04 (0.89–1.23)	1.02 (0.88–1.19)	1.00 (0.94–1.06)	1.02 (0.86–1.21)
Age (Continuous)	1.06 (1.02–1.11)	1.07 (1.05–1.09)	1.10 (1.10–1.11)	1.08 (1.05–1.12)	1.10 (1.08–1.12)	1.08 (1.06–1.09)	1.10 (1.09–1.11)	1.11 (1.09–1.13)
Family Poverty Ratio (Continuous)	0.998 (0.996–0.999)	0.997 (0.996–0.998)	0.996 (0.995–0.996)	0.997 (0.996–0.999)	0.998 (0.997–0.998)	0.996 (0.996–0.997)	0.995 (0.995–0.996)	0.995 (0.994–0.996)
Highest level of education (Reference: College degree or higher)
Less than high school	2.82 (1.39–5.74)	0.95 (0.72–1.26)	1.06 (0.85–1.33)	1.21 (0.68–2.15)	1.00 (0.62–1.61)	0.89 (0.68–1.18)	1.30 (1.01–1.67)	1.95 (0.86–4.42)
High school (including vocational, trade, or business school)	1.98 (1.17–3.37)	1.17 (0.93–1.46)	1.74 (1.58–1.92)	1.49 (0.93–2.37)	1.12 (0.88–1.42)	1.24 (0.99–1.54)	1.96 (1.79–2.16)	1.44 (1.10–1.88)
Some college or associate degree	1.85 (1.10–3.11)	1.38 (1.12–1.70)	1.76 (1.64–1.89)	1.62 (1.04–2.51)	1.39 (1.13–1.70)	1.41 (1.15–1.72)	1.91 (1.78–2.05)	1.68 (1.36–2.09)
Race/Ethnicity (Reference: White)
Asian	1.30 (0.71–2.37)	0.72 (0.58–0.88)	0.88 (0.64–1.21)	-----	-----	-----	-----	-----
Black/African American	3.90 (2.02–7.53)	1.61 (1.25–2.06)	1.55 (1.39–1.72)	-----	-----	-----	-----	-----
Hispanic	2.52 (1.40–4.57)	1.25 (1.04–1.51)	1.39 (1.24–1.56)	-----	-----	-----	-----	-----
Other	2.27 (0.96–5.38)	1.41 (1.14–1.76)	1.81 (1.64–2.01)	-----	-----	-----	-----	-----
Household generation (Reference: 1st Generation)
2nd generation	-----	-----	-----	1.09 (0.75–1.60)	0.81 (0.47–1.40)	0.86 (0.61–1.22)	2.34 (1.38–3.98)	1.90 (0.87–4.12)
3rd+ generation	-----	-----	-----	2.09 (1.31–3.31)	1.55 (0.93–2.56)	1.78 (1.25–2.52)	3.86 (2.30–6.47)	3.64 (1.72–7.69)

Certain race/ethnicity comparisons across household generation categories showed significant associations with the presence of ACEs. Among Black children, odds of having ACEs did not vary by household generation (p>0.08). Among White children, relative to first-generation, second- (AOR=2.34, 95%CI=1.38–3.98) and third- and higher generation children (AOR=3.86, 95%CI=2.30–6.47) had higher odds of having ACEs. Among Asian and Hispanic children, relative to first-generation children, only third- and higher generation children had higher odds of having ACEs (Asian: AOR=2.09, 95%CI=1.31–3.31; Hispanic: AOR=1.78, 95%CI=1.25–2.52). Among children belonging to the “Other” race/ethnicity category, relative to first-generation, third- and higher generation children (AOR=3.64, 95%CI=1.72–7.69) had higher odds of having ACEs. Older ages were associated with higher odds of having ACEs, while higher income levels were associated with lower odds of having ACEs. Lower parental educational levels were sporadically associated with higher odds of having ACEs across the different stratified analyses, while higher parental education levels were generally associated with increased odds of having ACEs.

The multinomial associations between the prevalence of experiencing ACEs, household generation, and race/ethnicity are provided in Table 5 (online) and highlight racial/ethnic differences in ACE counts (including high ACE counts historically associated with worse health outcomes) in each household generation. For example, in first-generation households, Black children had higher odds of exposure to 3+ ACEs than White children (AOR=7.54; p<0.05). Similar patterns persisted into second- and third- and higher generation households, although the magnitudes are reduced (e.g., AOR for third and higher generation=1.53; p<0.05). In third- and higher generation households, Hispanic children had higher odds than White children for exposure to 3+ ACEs (AOR=1.74; p<0.05). Generational differences also exist in some racial/ethnic groups. For example, among White children, compared to first-generation households, third- and higher generation households had even higher odds of exposure to 3+ ACEs (AOR=10.71; p<0.05). Moreover, Asian children in third- and higher generation households had higher odds than those in first-generation households of exposure to 3+ ACEs (AOR= 4.27; p<0.05).

Table 5.

Multinomial logistic regression associations between adverse childhood experiences scores, household generation, and race/ethnicity.

Variable	1st Generation – AOR (95% CI)	2nd Generation – AOR (95% CI)	3rd Generation – AOR (95% CI)	Asian – AOR (95% CI)	Black – AOR (95% CI)	Hispanic – AOR (95% CI)	White – AOR (95% CI)	Other – AOR (95% CI)
Race/Ethnicity (Reference: White)
Asian				-----	-----	-----	-----	-----
1 vs. 0	1.51 (0.77–2.98)	0.79 (0.62–0.99)	0.90 (0.64–1.27)	-----	-----	-----	-----	-----
2 vs. 0	0.60 (0.19–1.95)	0.71 (0.47–1.08)	0.89 (0.46–1.74)	-----	-----	-----	-----	-----
3+ vs. 0	1.63 (0.22–12.05)	0.41 (0.22–0.76)	0.79 (0.44–1.43)	-----	-----	-----	-----	-----
Black/African American				-----	-----	-----	-----	-----
1 vs. 0	3.69 (1.68–8.12)	1.65 (1.25–2.18)	1.48 (1.31–1.67)	-----	-----	-----	-----	-----
2 vs. 0	3.37 (1.06–10.73)	1.76 (1.11–2.79)	1.74 (1.49–2.03)	-----	-----	-----	-----	-----
3+ vs. 0	7.54 (1.18–48.00)	1.27 (0.72–2.24)	1.53 (1.30–1.80)	-----	-----	-----	-----	-----
Hispanic				-----	-----	-----	-----	-----
1 vs. 0	2.63 (1.32–5.22)	1.32 (1.07–1.63)	1.27 (1.11–1.45)	-----	-----	-----	-----	-----
2 vs. 0	2.79 (0.91–8.61)	1.09 (0.74–1.60)	1.41 (1.19–1.67)	-----	-----	-----	-----	-----
3+ vs. 0	1.95 (0.31–12.06)	1.17 (0.74–1.85)	1.74 (1.46–2.07)	-----	-----	-----	-----	-----
Other				-----	-----	-----	-----	-----
1 vs. 0	2.06 (0.75–5.65)	1.31 (1.03–1.68)	1.46 (1.29–1.65)	-----	-----	-----	-----	-----
2 vs. 0	1.80 (0.34–9.47)	1.63 (1.09–2.44)	1.98 (1.68–2.33)	-----	-----	-----	-----	-----
3+ vs. 0	5.36 (0.66–43.62)	1.67 (0.94–2.98)	2.75 (2.35–3.23)	-----	-----	-----	-----	-----
Household generation (Reference: 1st Generation)
2nd generation	-----	-----	-----
1 vs. 0	-----	-----	-----	1.02 (0.68–1.53)	0.84 (0.44–1.60)	0.88 (0.60–1.29)	2.22 (1.24–3.96)	1.59 (0.66–3.79)
2 vs. 0	-----	-----	-----	2.08 (1.01–4.27)	0.83 (0.38–1.81)	0.57 (0.32–1.01)	1.96 (0.71–5.43)	2.19 (0.58–8.29)
3+ vs. 0	-----	-----	-----	0.75 (0.23–2.44)	0.60 (0.23–1.56)	1.23 (0.63–2.40)	4.27 (0.87–20.90)	1.97 (0.53–7.24)
3rd generation	-----	-----	-----
1 vs. 0	-----	-----	-----	1.56 (0.94–2.59)	1.22 (0.66–2.24)	1.31 (0.89–1.93)	3.14 (1.79–5.53)	2.31 (0.99–5.39)
2 vs. 0	-----	-----	-----	4.42 (1.69–11.57)	1.90 (0.94–3.85)	1.56 (0.89–2.73)	3.71 (1.37–10.09)	4.70 (1.27–17.35)
3+ vs. 0	-----	-----	-----	4.27 (1.35–13.50)	2.21 (0.97–5.01)	5.15 (2.68–9.90)	10.71 (2.28–50.29)	7.35 (2.19–24.72)

CONCLUSIONS

Overall, our results suggest that ACEs remain widely prevalent in the U.S. children population, and the prevalence varies by race/ethnicity and immigration generations. Across all racial and ethnic groups except Black individuals, children in first- and second-generation households were less likely than those in third- and higher generation households to experience any ACEs related to household dysfunction. Our results are somewhat consistent with other studies that have reported lower prevalence of ACEs among children of immigrants compared to children of native-born parents^26,27, in part due to the presence of protective factors in first-generation households (e.g., social support, cultural practices) and presence of risk factors in second- or third- and higher generations (e.g., loss of family closeness).³⁵ Previous research also suggests that lower educational aspiration among children may explain this observation.³⁶ However, data from the NSCH provides mixed support. While parent educational attainment decreases among White and Asian households and coincides with increases in ACE exposure, parent educational attainment actually increases among Hispanic households and yet ACE exposure increases across generations. Additionally, we found that among White children, the “protective” effect of immigrant household disappears among children in second-generation households, a generation earlier than the household of other racial and ethnic groups. The reasons for this observation are unclear. Perhaps, children in White households assimilated in the U.S. society faster than children in racial and ethnic minority households, possibly because children in White immigrant households experience less discrimination. This hypothesis is supported by data showing that Hispanic individuals who were perceived by others as White experienced significantly less discrimination than Hispanic individuals who were perceived by others as Black or Hispanic individuals³⁷, and non-Hispanic White children experience fewer encounters with racial discrimination compared to other groups.³⁸ The complex relationships between racism, discrimination, xenophobia, immigration, and child health warrant further examination.

It is alarming that prevalence of ACE exposure remains stably high across generations among Black children, and Black and Hispanic children have higher prevalence of ACE exposure than their White peers. This might be related to pre-migration factors that impact experiencing traumatic and adverse experiences (e.g., coming from relatively less developed countries, experiencing armed conflict, experiencing or witnessing physical or sexual abuse, or living in areas with high rates of community and gang violence), as well as structural factors that disproportionately affect Black and Hispanic families (e.g., discrimination). ACEs can be transmitted over generations³⁹, resulting in persistently higher prevalence of ACE exposure in Black and Hispanic children than White children observed in this study. In contrast, children in second-generation Asian households were the only group that had lower prevalence of ACEs compared to their White counterparts. We speculate that one potential reason this may be the case is related to the anecdotes suggesting Asian immigrant parents emphasize educational attainment and future employment security. However, further studies need to examine potential factors that may explain this finding and can also be applied to interventions to reduce ACE prevalence. Importantly, individuals in the same racial and ethnic group can come from different countries and cultures, and pre-migration factors can also vary accordingly. Stratifying our analyses by race, ethnicity, and generation represents the first step to better disentangle their relationships with ACE exposure. Further analyses considering country of origin in conjunction with race, ethnicity, and generation can yield additional insight in this line of research. Unfortunately, the NSCH did not collect information on country of origin.

Together, our findings highlight the needs for addressing ACE among U.S. children, especially those from Black and Hispanic first- and second- generation immigrant households. Potential interventions include the delivery of trauma-informed services to Black and Hispanic children especially among immigrant households, as well as promoting protective factors (e.g., family closeness, cultural values and practices) and addressing risk factors (e.g., discrimination and xenophobia) to buffer the impact of cultural assimilation on household dysfunction.

A major strength of this study is the use of nationally representative population-based data with a large sample size, a relatively high response rate, which increase the generalizability of its findings. Study limitations include potential inaccuracy of self-reported data and the absence of important ACEs such as child abuse and neglect, which could be correlated with the presence of household challenge ACEs. Furthermore, not all ACE exposures are equally weighted in terms of their impact on downstream health outcomes, and some ACEs such as parental separation are more prevalent than others. Thus, the observed disparities in ACE exposure by race, ethnicity, and household generation may under- or over-estimate the disparities in downstream health disparities. Additionally, the third- and higher household generation, or non-immigrant household, is a heterogeneous group, which impacts general interpretability of the findings related to this subgroup. Still, this group provides a helpful representation of the general U.S. population and comparison group that includes both non-migrants and the descendants of migrants.

Despite the methodological limitations, this study found significant disparities in experiencing ACEs by race, ethnicity, and nativity. Furthermore, this analysis concerningly shows that ACEs have remained prevalent in racial and ethnic minority groups (particularly Black and Hispanic) across subsequent generations and have increased in prevalence in White children across later generations.

Table 6.

Prevalence (%) of individual adverse childhood experiences by household generation and race/ethnicity.

	1st Generation					2nd Generation					3rd Generation
Variable	Asian	Black	Hispanic	White	Other	Asian	Black	Hispanic	White	Other	Asian	Black	Hispanic	White	Other
ACE 1	12.3	33.8	25.0	4.3	31.2	8.4	23.6	20.5	11.4	15.3	10.2	26.9	25.9	17.2	28.2
ACE 3	8.2	17.0	27.4	7.6	22.4	6.7	19.5	18.7	13.4	11.4	15.8	35.0	30.6	21.2	30.8
ACE 4	2.0	3.1	2.0	2.7	1.9	1.7	3.3	1.8	1.4	1.5	3.9	6.4	4.0	2.1	3.2
ACE 5	1.5	3.8	2.3	0.9	6.1	1.3	2.5	4.0	2.3	1.8	2.4	16.4	10.7	5.4	14.0
ACE 6	2.5	7.4	5.1	1.8	8.7	3.0	2.3	4.4	2.9	4.2	3.4	9.3	7.5	4.5	9.1
ACE 7	1.8	10.3	6.3	2.6	6.3	1.6	2.6	4.0	2.1	2.1	2.0	8.8	6.3	3.0	7.6
ACE 8	1.9	6.0	4.5	3.9	8.0	2.9	4.0	4.4	5.3	6.6	3.7	8.8	11.2	8.6	12.7
ACE 9	3.9	4.6	7.7	1.8	0.7	1.4	2.4	5.3	4.1	5.3	4.5	8.3	11.7	8.6	13.7
ACE 10	5.7	15.7	6.8	3.0	12.3	4.8	6.2	4.6	2.0	5.9	11.4	13.1	6.7	1.3	11.8

ACE 1 = Hard to cover basics like food or housing

ACE 3 = Parent or guardian divorced or separated

ACE 4 = Parent or guardian died

ACE 5 = Parent or guardian served time in jail

ACE 6 = Saw or heard parents or adults slap, hit, kick punch one another in the home

ACE 7 = Was a victim of violence or witnessed violence in neighborhood

ACE 8 = Lived with anyone who was mentally ill, suicidal, or severely depressed

ACE 9 = Lived with anyone who had a problem with alcohol or drugs

ACE 10 = Treated or judged unfairly because of his or her race or ethnic group

Abbreviations:

ACEs

adverse childhood experiences