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Economic Hardship in Childhood: A Neglected Issue in ACE Studies?

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Abstract

Objectives Adverse childhood experiences (ACEs) have been linked with ill-health in adulthood, but ACE literature has focused on family disruption or dysfunction (e.g., child abuse, parental separation), with less attention to economic adversity. We examined whether a mother’s economic hardship in childhood (EHC) was associated with women’s hardships and health-risk behaviors during/just before pregnancy. Methods We analyzed population-based survey data on 27,102 postpartum California women. EHC included respondents’ reports that during childhood they/their families experienced hunger because of inability to afford food or moved because of problems paying rent/mortgage and the frequency of difficulty paying for basic needs. We examined six maternal hardships/behaviors during/just before pregnancy, including four hardships (poverty, food insecurity, homelessness/no regular place to sleep, intimate partner violence) and two behaviors (smoking, binge drinking). Prevalence ratios (PRs) were calculated from sequential logistic regression models estimating associations between EHC (categorized by level of hardship) and each maternal hardship/behavior, first without adjustment, then adjusting for other childhood and current maternal factors, and finally adding family disruption/dysfunction. Results Before adjustment for family disruption/dysfunction, the highest and intermediate EHC levels were associated with each maternal hardship/behavior; after full adjustment, those associations persisted except with smoking. Higher EHC levels generally appeared associated with larger PRs, although confidence intervals overlapped. Conclusions for Policy/Practice These findings link childhood economic hardship with women’s hardships, binge drinking, and possibly smoking around the time of pregnancy. Without establishing causality, they support previous research indicating that childhood economic adversity should be considered an ACE.

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Acknowledgements

This study was supported by Title V Block Grant funding from the California Department of Public Health.

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Authors and Affiliations

  1. Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, USA

    Paula Braveman, Katherine Heck, Susan Egerter & Kristen Marchi

  2. Surveillance, Assessment and Program Development Section, Epidemiology, Assessment and Program Development Branch, Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, USA

    Christine Rinki & Mike Curtis

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  1. Paula Braveman
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  2. Katherine Heck
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  3. Susan Egerter
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  4. Christine Rinki
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Correspondence to Paula Braveman.

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Braveman, P., Heck, K., Egerter, S. et al. Economic Hardship in Childhood: A Neglected Issue in ACE Studies?. Matern Child Health J 22, 308–317 (2018). https://doi.org/10.1007/s10995-017-2368-y

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  • DOI: https://doi.org/10.1007/s10995-017-2368-y

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