Race, gender, and childhood adversity: gender-specific prevalence of ACE exposure among Black Americans.

OBJECTIVE

Adverse childhood experiences (ACEs) are prevalent and have profound negative health impacts across the life course. This study examined childhood adversity prevalence among US non-Hispanic Black adults, with particular attention to gender specific patterns in cumulative risk, individual ACE types and associated sociodemographic factors.

DESIGN

We analyzed data from Black adults aged 18 and older who completed the 2019 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Childhood adversity indicators were derived from the ACE Module administered in 21 states. Individual ACE exposures were dichotomized, and we calculated prevalence estimates and cumulative risk scores for Black women and Black men separately.

RESULTS

The analytic sample included 14,685 non-Hispanic Black adults (62% Black women). Over half (54%) reported experiencing at least one ACE, with 19% of Black women and 15% of Black men reporting four or more ACEs - a threshold indicating high risk for toxic stress. Black women experienced significantly higher rates of childhood sexual abuse, while Black men reported more childhood physical abuse than Black women (28% vs 23%, p = 0.003). Higher cumulative risk ACE scores were inversely associated with socioeconomic position.

CONCLUSIONS

The observed gender differences in childhood adversity prevalence among Black adults likely reflect distinct social and structural risk factors. These differential ACE patterns suggest that pathways to toxic stress exposure may vary by gender within Black communities. Understanding these distinctions is crucial for developing targeted interventions and addressing the structural determinants that contribute to health inequities in communities disproportionately affected by childhood adversity.