The 3E Study: Economic and Educational Contributions to Emerging Adult Cardiometabolic Health

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PROJECT SUMMARY/ABSTRACT Adverse Childhood Experiences (ACEs) may contribute to inequities in cardiometabolic health disproportionately experienced by Latinx emerging adults. With the increased use of ACE measures in health research, there is a need to consider how well the measures work in diverse populations and whether ACEs categories need to be expanded to include community-level adversity. First, although existing ACE measures have been used to understand how adversity early in life impacts the adoption of risky health behaviors and long-term health, the original measures were developed with a population that had health insurance and was largely white and well-educated; they do not necessarily reflect the diversity of adverse childhood experiences that may be disproportionately experienced by some communities (e.g., immigration-related traumas, policing-related traumas). More work needs to be done to understand how applicable they are to more diverse populations. Second, Dr. Felitti’s original ACEs measures, typically referred to as “conventional ACEs,” were focused on household-level adversity (psychological, physical or sexual abuse; domestic violence against the mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned). Increasingly, researchers recognize that experiences outside the home also shape the lives of children and influence health and health behavior, especially for people from minoritized racial/ethnic groups and/or those living in poverty, and are calling for expanded ACE measures that address interpersonal and community-level adversity. Expanded ACE measures can include experiences of poverty, racism, discrimination, bullying, immigration-specific adversity, and community violence. In addition to expanding ACEs to include community level adversity, it may be useful to consider the framework of resilience or positive childhood experiences. Narayan et al. developed the Benevolent Childhood Experiences (BCE) scale that focuses on promotive factors. Measures include positive experience with parents, peers, teachers, and extended social networks, a supportive environment, and a predictable routine. The objectives of this diversity supplement are 1) to develop an ACE scale specific to community level stressors (poverty, racism, discrimination, bullying, immigration specific adversity and community violence), 2) to quantify ACEs and BCEs in the 3E study’s cohort of diverse emerging adults, and 3) to use qualitative methods to document and contextualize how adversity impacts cardiometabolic behaviors (diet, physical activity, sleep, and smoking) and cardiometabolic health (weight and blood pressure). The evidence generated from this work could inform future community-level interventions targeting determinants of cardiometabolic health and will position the candidate to have an impactful career as an independent researcher investigating the impact of community level adverse childhood experiences on cardiometabolic health in diverse populations.