November 21, 2019
Trauma and adversity in childhood raise the risk of numerous health problems such as diabetes, heart disease, cancer, and mental illness in adulthood.1 Several recent studies found that women who experienced childhood adversity are more likely to have their first child early or outside of marriage and face a higher risk of cancer than men. Lower-income women are particularly vulnerable to health issues related to adverse childhood experiences (ACEs). And of all ACEs, child abuse may affect adult health more directly than any other.
“Childhood adversity creates a chain of risk that has a lifelong impact on health; preventing adversity and promoting resilience among exposed youth should be a public health priority like obesity and high blood pressure,” argues Kristi Williams, an Ohio State University sociology professor affiliated with their Institute for Population Research.
Researchers are still trying to fully explain how experiences in a person’s early years shape their health decades later.
“There’s physical and biological evidence that toxic stress alters brain development affecting health in later life; our research shows that social processes also play a key role,” explains Williams.
Williams and her collaborator, Brian Karl Finch of the University of Southern California, examined several types of ACEs by analyzing 25 years of data from the nationally representative National Longitudinal Study of Youth: 2
They found that that the more ACEs women were exposed to as children, the more likely they were to have an early first birth (before age 25) or a first child outside of marriage, which in turn were strongly related to poorer health by around age 40.
Experiencing childhood adversity is as strongly related to early and unmarried childbearing as is being from a socioeconomically disadvantaged household, the researchers report.
Preventing adversity and promoting resilience among exposed youth should be a public health priority…
Exposure to trauma affects emotional regulation, impulsivity, and ability to form intimate ties, according to Williams. Earlier studies have linked ACEs to risky sexual behavior, adolescent childbearing, and unintended pregnancy. This new study provides evidence on the relationship among ACEs, early and nonmarital childbearing, and health problems in later life.
Williams suggests that programs targeting teenagers with messages about preventing early pregnancy may be “too little, too late.”
“Interventions that promote the so-called ‘success sequence’ of completing high school, securing employment, and waiting until age 21 to marry and have children may be ineffective at reducing poverty and improving the well-being of women and children, if, as our results suggest, ACEs are fundamental precursors to nonmarital and early fertility,” the researchers write.
In Williams’ view, reducing children’s exposure to stress and adversity may be more effective in improving maternal and child health and well-being.
Another recent study shows exposure to childhood adversity is linked to a higher lifetime cancer risk among women—but not among men.3 This study is among several studies supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) that are probing the long-term effects of childhood adversity, offering insights into early-life interventions that could pay health dividends later in life.
Using data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS), a national survey of 112,000 American adults ages 18 and older, researchers examined whether respondents reported any of eight kinds of ACEs and a lifetime cancer diagnosis (excluding skin cancer). Their analysis, which took into consideration smoking and other factors, showed that among women, seven ACEs (physical, sexual, or emotional abuse; or living with someone who was mentally ill, a problem drinker, a drug user, or in a household where adults treated each other violently) were associated with higher cancer risk. For men, only one ACE—emotional abuse—was linked to greater cancer risk. Neither men nor women face increased odds of receiving a cancer diagnosis if they had separated or divorced parents.
The researchers, based at Stony Brook University and the University of California Los Angeles, note that women experience many ACEs at higher rates than men, and sexual abuse can expose them to cancer-causing viruses such as HPV. The researchers point out that women with histories of childhood sexual abuse may avoid cervical cancer screenings, and they recommend making less-invasive options available.
Lower-income women appear more vulnerable to the health impact of childhood adversity than higher-income women, another study shows.4 University of Texas at Austin researchers used data on a representative sample of 2,400 California mothers ages 30 and older with young children from the Geographic Research on Wellbeing survey (GROW) conducted in 2012-2013. They examined the relationship between a set of family-related childhood adversities (neglect, hunger, foster care, frequent racial/ethnic discrimination, and parental alcohol/drug abuse, divorce, or incarceration) and important chronic diseases and related conditions (diabetes, hypertension, high cholesterol, and heart disease).
They found that higher levels of childhood adversity increased the odds of reporting one or more chronic diseases after taking into account age, race/ethnicity, marital status, education, and income. Each unit increase in the number of adversities experienced corresponded to about a 10-percent increase in the odds of reporting one or more chronic diseases. Having an income at least twice the poverty level buffered the adult health impacts of childhood adversity.
Their analysis showed diabetes and high cholesterol levels were the main chronic conditions linked to family adversity, potentially pointing to the role of dietary differences that could be addressed. They suggest that these results provide “further evidence of the health-damaging impact of experiencing adversity during childhood,” particularly economic- and family-related adversity.
Policies that expand “living wages, paid family leave, and affordable housing can support families’ economic well-being and stability,” the researchers argue.
High levels of cortisol—the stress hormone—are linked to health problems, but studies show that having stable and supportive caregivers can buffer or prevent elevated cortisol in response to distressing situations. The researchers suggest that “expanding family support services could reduce parental stress and improve parenting skills for socioeconomically disadvantaged families, potentially offsetting” the impacts of family adversity on children’s later health.
The researchers also recommend “evidence-based, trauma-informed interventions” for affected children and their families. These types of interventions are provided by people who are trained to recognize the signs of trauma, understand that children’s misbehavior is often a response to highly stressful situations, and adjust procedures in ways that support the child’s resilience.5
Child abuse may affect adult health more directly than other adversity or family dysfunction.6 Researchers from the University of Texas at Austin and Ohio State University used BRFSS data to explore the relationship among the number and type of ACEs and five health risks—depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health. Their analysis assessed whether social and economic conditions in adulthood—marriage, divorce and separation, educational attainment, income, and insurance status—affected the relationship between ACEs and health.
Their analysis showed that the health risks related to domestic violence, and parental divorce or incarceration were nearly entirely explained by socioeconomic conditions in adulthood. But they found that child abuse (physical, emotional, and sexual) was strongly associated with several adult health risks, independent of the effects of other adversities, and that socioeconomic conditions in adulthood explained only a small portion of these associations. “These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact,” they report.
The researchers argue that improving the efficacy of states’ child protection systems may reduce the impacts of childhood adversities on adult health because “unlike other adversities children may face, the responsibility and authority of the government to protect children from abuse, and to intervene when abuse has occurred, is explicit.” In addition, they note that in some state statutes, other ACEs can be defined as forms of child neglect, such as exposure to domestic violence or parental substance abuse, which can also trigger intervention.
For those with adverse experiences other than abuse, “interventions focused on improving their socioeconomic opportunities may have a protective effect against depression, tobacco use, obesity, and self-reported sub-optimal health,” they write. Additional interventions they suggest include early learning opportunities and kindergarten readiness to improve school achievement for young children, and dropout prevention and preparedness for the workforce to improve economic opportunities for teens.
The researchers report a link between ACEs and adult relationship difficulties but note that interventions to promote marriage and prevent divorce among adults have had little success. They suggest that intervening earlier may help: “To the extent that childhood adversities can result in insecure attachments and interfere with the formation of healthy relationships throughout the life course, interventions promoting secure attachment in childhood may reduce the risks of divorce and separation in adulthood.”
This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population research centers was highlighted in this article: Ohio State University, University of Texas at Austin, and University of California Los Angeles.
 Centers for Disease Control and Prevention, Adverse Childhood Experiences Journal Articles by Topic Area, https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/journal.html.
 Kristi Williams and Brian Karl Finch, “Adverse Childhood Experiences, Early and Nonmarital Fertility, and Women’s Health at Midlife,” Journal of Health and Social Behavior 60, no 3 (2019): 1-17.
 Hector Alcalá, A. Janet Tomiyama, and Ondine von Ehrenstein, “Gender Differences in the Association Between Adverse Childhood Experiences and Cancer,” Women’s Health Issues 27, no. 6 (2017): 625-31.
 Catherine Cubbin, Yeonwoo Kim, and Lisa S. Panisch, “Familial Childhood Adversity Is Associated With Chronic Disease Among Women: Data From the Geographic Research on Wellbeing (GROW) Study,” Maternal and Child Health Journal 23, no. 8 (2019): 1117-29.
 Jessica Dym Bartlett and Kathryn Steber, “How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma,” Child Trends, May 9, 2019, https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma.
 Sarah A. Font and Kathryn Maguire-Jack, “Pathways From Childhood Abuse and Other Adversities to Adult Health Risks: The Role of Adult Socioeconomic Conditions,” Child Abuse and Neglect 51, no. 2 (2016): 390-9.