100 - Adverse Childhood Experiences and Freedom From Household Material Hardships Among Mothers of Young Children

Poster Number: 100
Publication Number: 100.212

Felice Le-Scherban, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Stephanie Ettinger de Cuba, Boston University School of Medicine, Boston, MA, United States; Lindsey Rateau, Boston University School of Public Health, BOSTON, MA, United States; Timothy Heeren, Boston University School of Public Health, Boston, MA, United States; Kelly Courts, St. Christopher's Hospital, Philadelphia, PA, United States; Sarah K. Canale, Boston Medical Center, Boston, MA, United States; Deborah Frank, Boston University School of Medicine, Brookline, MA, United States; Diana B. Cutts, Hennepin Healthcare, Minneapolis, MN, United States; Allison Bovell-Ammon, Boston Medical Center - Children's HealthWatch, Boston, MA, United States; Megan T. Sandel, Boston University School of Medicine, Boston, MA, United States

Background: Adverse childhood experiences (ACEs) and household material hardships (e.g., food insecurity, housing instability) each have long-lasting and intergenerational health impacts. Relationships of ACEs with food insecurity and other hardships have been demonstrated, but the relationship with freedom from multiple household hardships (hardship-free) has not been explored. Material hardships are potentially remediable as a promising means of addressing some downstream effects of past maternal ACEs.

Objective: To examine associations between ACEs and odds of having a hardship-free household among mothers of young children.

Design/Methods: We used cross-sectional survey data (2019-2020) of mothers with children < 4 years in 4 US cities presenting for care at emergency departments (ED) or primary care clinics in hospital settings. The predictor was maternal ACEs, categorized as 0, 1-3, >4. The outcome was being hardship-free, defined as reporting none of the following household hardships: food insecurity, energy insecurity (inability to afford utilities), housing instability (homelessness, behind on rent, multiple moves) and/or healthcare hardship (forgone health care for child or other household member or difficulty paying for household basic needs as a consequence of medical costs). Adjusting for covariates, logistic regression evaluated associations of maternal ACEs with hardship-free status. Secondary models also included the interaction of maternal race/ethnicity & ACEs.

Results: Among 1,657 mother/child dyads, 82% of children had public insurance; 54% of mothers self-identified as non-Latina Black, 21% Latina, 20% non-Latina White, and 5% Other race/ethnicity. 55% (910) of mothers reported at least one ACE and 14% reported ≥4. Compared to those with no ACEs, adjusted analyses showed families of mothers with 1-3 ACEs had 53% lower odds (AOR=0.47, [95% CI 0.37–0.61]) and those with >4 ACEs had 82% lower odds (AOR=0.18, [95% CI 0.12–0.25]) of being hardship-free (trend pConclusion(s): Maternal ACEs were associated with far lower odds of being hardship-free. Though past maternal ACEs are immutable, material hardships are remediable, thus findings support need for trauma-informed approaches to material hardship interventions as well as efforts to prevent and reduce ACEs for children.