Immigrant parents report fewer adverse childhood experiences than US-born parents

September 15, 2017

CHICAGO - A new study found immigrants reported fewer potentially health-harming adverse childhood experiences, such as abuse, violence, or divorce, than native-born Americans. The findings, which will be highlighted in an abstract presentation during the American Academy of Pediatrics 2017 National Conference & Exhibition, suggest immigrants may experience different forms of stress early in life than do those born in the United States.

The abstract, "Adverse Childhood Experiences Among Immigrants and their Children," will be presented on Sunday, Sept. 17 at McCormick Place in Chicago.

Prior research shows half of the U.S. population had at least one adverse childhood experience, or ACE, such as abuse, neglect, household violence, substance abuse or mental illness, or loss of family members through divorce, separation or incarceration. As many as one-third experienced four or more, which puts them at higher risk for later depression, violent behavior, and a number of chronic diseases.

"Our findings suggest that violence, abuse, and neglect may be much less common in the lives of immigrant parents and their children than in the lives of U.S.-born counterparts. This may challenge assumptions about immigrants and what their unique health risks and needs may be," said Keith Martin, DO, MS, one of the abstract's authors and third-year pediatrics resident Children's Mercy Hospital in Kansas City.

Dr. Martin and his colleagues conducted a secondary analysis of data collected for a study on ACEs and child weight that involved 6- to 12-year-old children treated at general pediatrics or weight management clinics at two Midwest academic hospitals and their parents. Emerging evidence suggests a direct relationship between parent ACEs and child adversity, Dr. Martin said. Among children enrolled in the Head Start program, for example, children of parents with four or more ACEs were at increased risk for their won ACEs, including homelessness, neglect, community violence and multiple forms of family dysfunction.

Difference between participants who reported being native born were compared against those born outside the United States, adjusting for parent gender, income, and education, as well as child race, ethnicity, age, and insurance. Compared to immigrant parents, the researchers found that U.S.-born parents reported experiencing more ACES, most commonly loss of a parent (40 percent), poverty (32 percent), and bullying (32 percent), while among immigrant parents, the most common ACEs were poverty (30 percent), unsafe neighborhood (20 percent), and emotional neglect (18 percent).

U.S.-born parents also reported more ACEs for their children. Among children of U.S.-born and immigrant parents, the most common ACEs were parent loss (31 percent and 22 percent, respectively) poverty (37 percent and 17 percent), and bullying (39 percent and 12 percent).

Dr. Martin said differences revealed in the study may result from different interpretations of ACE-related questions based on culture or language. Another possibility, Dr. Martin said, is that they reflect what researchers call the "immigrant paradox," a phenomenon identified in earlier studies that suggest immigrants generally report higher levels of health, achievement and well-being than U.S.-born patients, despite greater disadvantage such as poverty, low educational level, poor access to health care, legal status, language barriers, and discrimination.

"The public's perception of immigrants influences the development of immigration policy," Dr. Martin said. "We believe this research has the potential to help inform public perception and immigration policy so that they accurately reflect the reality experienced by immigrant families and children in the United States."
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Dr. Martin will present the abstract, available below, between 5 p.m. and 6 p.m. McCormick Place West room W185A.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Adverse Childhood Experiences Among Immigrants and their Children

Purpose: To compare parent-reported adverse childhood experiences (ACEs) between immigrant and US-born parents and their children. Methods: Data were obtained for secondary analysis from a study examining ACEs and child weight. Parents of 6-12 year-old children in general pediatrics or weight management clinics of two Midwest academic hospitals completed an anonymous questionnaire assessing 10 conventional/household-level parent ACEs, 6 conventional child ACEs (out-of-home placement used as proxy for abuse/neglect questions), and 6 expanded/community-level parent and child ACEs. Summed ACE scores for each parent and child were grouped as 0, 1-3, and ? 4 (conventional) or 0, 1-2, and ? 3 (expanded). Immigrant status was determined by asking, "Were you/your child born in the United States?" Differences between groups were analyzed using bivariate and multinomial logistic regression, adjusting for parent gender, income, and education, as well as child race, ethnicity, age, and insurance. Results: 331 parents participated of whom 67% were born in the US, 87% were female, and 69% spoke primarily English at home. 50% had annual income < $20,000. 99% of children were born in the US. The majority of children of immigrant parents were Hispanic (94%). Compared to immigrant parents, US-born parents reported experiencing more conventional and expanded ACEs (Table 1). Among US-born parents, the most common ACEs were loss of parent (40%), poverty (32%), and bullying (32%), while among immigrant parents, the most common ACEs were poverty (30%), unsafe neighborhood (20%), and emotional neglect (18%). Compared to immigrant parents, US-born parents also reported higher conventional and expanded ACE scores for their children (Table 1). Among children of US-born and immigrant parents, the most common ACEs were parent loss (31%, 22%), poverty (37%, 17%), and bullying (39%, 12%). Adjusting for covariates, US-born parents were more likely than immigrant parents to report experiencing 1-3 conventional ACEs (RRR 2.4 [95% CI: 1.3,4.5]), ? 4 conventional ACEs (RRR 2.7 [95% CI: 1.2,6.2]), and ? 3 expanded ACEs (RRR 4.6 [95% CI: 2.0,10.9]). Children of US-born parents had higher risk for report of 1-3 conventional ACEs (RRR 2.0 [95% CI: 1.1,3.8]), 1-2 expanded ACEs (RRR 3.4 [95% CI: 1.7,6.7]) and ? 3 expanded ACEs (RRR 10.3 [95% CI: 2.5,42.2]). Conclusions: Immigrant parents reported significantly fewer ACEs for themselves and their children than US-born parents did. This example of the "immigrant paradox" (better health, achievement or well-being despite disadvantages) appears to apply not only to first generation immigrant adults, but to their US-born children, as well. The amount and type of ACEs experienced by non-Hispanic immigrant or refugee communities may differ significantly from these findings. Further study among more diverse immigrant populations should examine ACEs that may be unique to immigrants.

American Academy of Pediatrics

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