Lê-Scherban Félice, Coleman Sharon M, Fusfeld Zachary, Frank Deborah A, Poblacion Ana, Black Maureen M, Ochoa Eduardo, Sandel Megan, Ettinger de Cuba Stephanie
Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Drexel Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
Soc Sci Med. 2025 Feb;366:117695. doi: 10.1016/j.socscimed.2025.117695. Epub 2025 Jan 10.
Growing evidence shows parents' exposure to adverse childhood experiences (ACEs) and lifetime experiences of racial discrimination (EOD) negatively impacts not only their own health, but also their children's health. ACEs and EOD can be conceptualized as a reflection of shared underlying adversities and structural injustices that manifest in inequitable educational and employment opportunities and differential treatment by public policies and programs that impede parents' capacity to support their families. Therefore, a potentially important, but underexplored, mechanism of effects of parent ACEs and EOD on the next generation is through effects on household material hardships. Using cross-sectional survey data collected from 1629 mothers of young children aged <4 years during pediatric healthcare visits in four US cities (Baltimore, MD; Boston, MA; Little Rock, AR; Philadelphia, PA), we examined individual and joint associations of mothers' ACEs and EOD with their health and their children's health, as well as household-level material hardships. In demographics-adjusted Poisson and multinomial logistic regression models, mothers who had experienced high ACEs, high EOD, or high combined ACE-EOD reported more household hardships and were less likely to report that they and their young children were in good health. Mediation analyses showed evidence that associations with maternal health were partially mediated by household hardships. Our results suggest that maternal ACEs and EOD may undermine maternal and child health via household hardships, along with other potential mechanisms. Counteracting downstream effects of these adversities requires timely intervention on multiple levels, including addressing remediable household hardships. Ultimately, a focus on achieving equity comprehensively through policy design and implementation is needed to realize the full potential of public policies for supporting family and child health.
越来越多的证据表明,父母童年期不良经历(ACEs)以及一生的种族歧视经历(EOD)不仅会对他们自身的健康产生负面影响,还会对其子女的健康产生负面影响。ACEs和EOD可以被视为共同潜在逆境和结构性不公正的反映,这些逆境和不公正表现为教育和就业机会不平等,以及公共政策和项目的差别待遇,而这些政策和项目阻碍了父母养家糊口的能力。因此,父母的ACEs和EOD对下一代产生影响的一个潜在重要但未得到充分探索的机制是通过对家庭物质困难的影响。利用在美国四个城市(马里兰州巴尔的摩市、马萨诸塞州波士顿市、阿肯色州小石城市、宾夕法尼亚州费城)儿科医疗就诊期间从1629名4岁以下幼儿的母亲那里收集的横断面调查数据,我们研究了母亲的ACEs和EOD与其自身健康、子女健康以及家庭层面物质困难之间的个体关联和联合关联。在人口统计学调整后的泊松回归模型和多项逻辑回归模型中,经历过高ACEs、高EOD或高ACE-EOD组合的母亲报告的家庭困难更多,而且不太可能报告她们自己和年幼子女健康状况良好。中介分析表明,与母亲健康的关联部分是由家庭困难介导的。我们的结果表明,母亲的ACEs和EOD可能通过家庭困难以及其他潜在机制损害母婴健康。抵消这些逆境的下游影响需要在多个层面及时进行干预,包括解决可补救的家庭困难。最终,需要通过政策设计和实施全面关注实现公平,以充分发挥公共政策在支持家庭和儿童健康方面的潜力。