The Intersection of Adverse Childhood Experiences and Neighborhood Determinants of Health: An Exploratory Spatial Analysis

• Published in: Psychological trauma 2024-04, Vol.16 (S1), p.S125-S132
• Main Authors: Skiendzielewski, Kristin, Forke, Christine M., Sarwer, David B., Noll, Jennie G., Wheeler, David C., Henry, Kevin A., Schroeder, Krista
• Format: Article
• Language: English
• Subjects: Adult; Adverse Childhood Experiences; Built Environment; Childhood Adversity; Cross-Sectional Studies; Drug Overdoses; Female; Human; Humans; Male; Mental Health; Neighborhoods; Poverty; Residence Characteristics; Surveys and Questionnaires; Trauma
• ISSN: 1942-9681; 1942-969X; 1942-969X
• DOI: 10.1037/tra0001320

Objective: Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship between ACEs and characteristics of the neighborhood environment is a necessary first step in determining if and how place-based, trauma-informed interventions might mitigate the negative effects of ACEs. The purpose of this exploratory study was to describe the neighborhood environment of adults who have experienced ≥ 4 versus ≤ 3 ACEs. Method: An exploratory secondary analysis of cross-sectional and geospatial data was conducted during 2021. Data sources included 2011/2012 Philadelphia ACE Survey data, a telephone survey of 1,784 randomly sampled Philadelphia adults, linked with geospatial data on 21 neighborhood-level determinants of health. Neighborhood was defined as participant's home census tract at the time of survey. The sample for this secondary analysis included the 1,679 Philadelphia ACE Survey participants for whom home census tract was available. Bivariate logistic regression examined differences between groups (≤ 3 ACEs vs. ≥ 4 ACEs). Results: Individuals with ≥ 4 ACEs lived in neighborhoods with higher neighborhood poverty rates, less socioeconomic resources, worse food access, poorer perceived physical and mental health, more substance overdose deaths, higher crime, and less green space. Conclusions: Findings suggest future work may benefit from considering neighborhood environments when examining and intervening upon the association between ACEs and poor physical and psychological health. Clinical Impact Statement This study suggests possible social, economic, and environmental inequities in the neighborhood environment of those who have experienced ≥ 4 versus ≤ 3 adverse childhood experiences. These differences may exacerbate negative health outcomes within this population and should therefore be considered during future research, clinical practice, resource allocation, and when developing trauma-informed public interventions and policy.