Parent-Reported Adverse Childhood Experiences (ACEs) and Food Insecurity Among Children in Non-English-Speaking Households in the United States

doi:10.21203/rs.3.rs-4850491/v1

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Parent-Reported Adverse Childhood Experiences (ACEs) and Food Insecurity Among Children in Non-English-Speaking Households in the United States

https://doi.org/10.21203/rs.3.rs-4850491/v1

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Adverse childhood experiences (ACEs) are potentially traumatic events associated with the risk of food insecurities in the United States. However, there are limited studies investigating this association, particularly for children aged 0–17 in non-English-speaking households. Therefore, this study examines the association between individual and cumulative ACEs and food insecurity for children in non-English-speaking households in the U.S. Using data extracted from the 2022 National Survey of Children's Health (NSCH), an analytic sample of 4677 children aged 0–17 was obtained. The dependent variable was binary food insecurity (food secure vs. food insecure). Independent variables included 11 individual ACEs (i.e., economic hardship, parent/guardian divorce, etc) and cumulative ACEs (0 ACE, 1 ACE, 2 ACEs, and 3 ≥ ACEs). Data were analyzed using six sets of multivariate logistic regression models with household food insecurity as an outcome variable across ACEs while controlling for individual, family, and community-level characteristics. Of the 4677 children, 22.4% experienced at least one or more ACEs, and 4.5% experienced food insecurity. After controlling for other factors, individual ACEs, including family economic hardships (aOR = 13.2), parents/guardians divorced (aOR = 2.65), and parents/guardians died (aOR = 3.59) were associated with higher odds of food insecurity among children. After covariates adjustment, children with at least one ACEs (aOR = 1.98), two ACEs (aOR = 3.51), and three or more ACEs (aOR = 2.25) were associated with higher odds of food insecurity compared with children with no ACEs. Therefore, preventing ACEs is crucial to mitigate their negative impact on food insecurity for children and their families. Interventions should focus on preventing ACEs and increasing financial resources needed for economic support, which can be strengthened through public assistance programs such as Supplemental Nutrition Assistance Programs (SNAPs) and Women and Infant programs (WIC) or supplemented by existing social support systems so low-income non-English-speaking families can afford food.

Social Work

Adverse childhood experiences

Children

food insecurity

Non-English-speaking households

United States

Food insecurity is the condition in which the availability of nutritionally safe and adequate foods, or the ability to acquire acceptable foods in socially acceptable ways, is uncertain or limited (National Research Council, 2006). Food insecurity may also denote the lack of access to the right amount and kinds of food necessary for each household member to lead an active and healthy lifestyle (Bahn et al., 2021; Smith & Gregory, 2023; Omachi, 2023). Consequently, food insecurity is recognized as a national public health issue in the United States (Drennen et al., 2019; Nord, 2014), affecting over 12.8 percent (17.0 million households) of the population, including 5.1 percent (6.8 million households) that experienced very low food security (Hales & Coleman-Jensen, 2024; U.S. Department of Agriculture Economic Research Service, 2023). This issue is particularly prevalent among vulnerable racial minority groups and low-income households, for example, 5.4% of Asian households to 23.3% for American Indian and Alaska Native households experience food insecurity in the U.S (Hales & Coleman-Jensen, 2024). Furthermore, specific rates include American Indian at 23%, Alaska Native at 22.4%, Black at 20.8%, Hispanic and other multiracial groups at 22.7%, more than double the 9.3% observed among White households (Hall, 2023).

Food insecurity among young children is also a significant social problem concerning in the U.S. The lack of nutritious food among children is associated with violent behavior, hospitalization, poor health conditions, and adverse long-term effects on child development and overall well-being (Drennen et al., 2019; Gundersen & Ziliak, 2015; Shankar et al., 2017). The most recent study has shown that food insecurity affects 17.3% (6.4 million) of households with children in the U.S (Hales & Coleman-Jensen, 2024). Specifically, children in non-English-speaking households are more likely to experience food insecurity compared to those in English-speaking households (Coleman-Jensen et al., 2020; Hall, 2023). Many of these non-English-speaking households are immigrants facing additional resettlement challenges that hinder access to education, job opportunities, and other income-generating activities, further exacerbating their food insecurity (Chipalo, 2023). Immigrants to the U.S. are much more likely to be food insecure than those born in the U.S. In some conservative states, fear of immigration enforcement, and language barriers may create insurmountable barriers accesing food supply (Gutierrez, 2022). Ample evidence further suggests that immigrants face not only interpersonal discrimination, but also systemic racism that makes obtaining jobs and applying for food assistance becomes more challenging (Chipalo, 2023; Gutierrez, 2022; Born, 2018).

Adverse Childhood Experiences and Food Insecurity

Similar to food insecurity, adverse childhood experiences (ACEs) are a public health crisis that is harmful and responsible for insurmountable traumatic intrafamilial events. ACEs refer to instances of physical, emotional, sexual, or general maltreatment occurring during the first 17 years of life (Boullier & Blair, 2018; Felitti et al., 1998; Trivedi et al., 2021; Chipalo, 2024). ACEs encompass events such as parental divorce, witnessing intimate partner violence, parental mental illness, economic hardship, parental or guardian imprisonment, maltreatment, abuse, neglect, and household dysfunction, which are often categorized into physical, sexual, and emotional violence (Brown et al., 2023; Hughes et al., 2017; Negriff, 2021; Chipalo, 2024; Chipalo & Jeong, 2024). Other studies have further shown that food insecurity is linked with increased risks of experiencing violence, neglect, substantiated child maltreatment, self-reported abuse and neglect, and parent-to-child aggression, all of which are characterized as ACEs (Helton et al., 2019; Mersky & Janczewski, 2018; Kim et al., 2023; Gyasi et al., 2022). A recent study estimated that 63.9% of U.S. adults have experienced at least one ACE, with 17.3% having four or more ACEs. Experiencing four or more ACEs is most common among Alaska Native or non-Hispanic American Indian adults (32.4%), non-Hispanic multiracial adults (31.5%), adults with less than a high school education (20.5%), and those who were unemployed (25.8%) or unable to work (28.8%) (Aslam et al., 2024; Swedo et al., 2023). Other findings also confirm a higher prevalence of ACEs among Black, Hispanic, and multiracial individuals in the U.S (Aslam et al., 2024; Merrick et al., 2018; Swedo et al., 2023).

Beyond the commonly recognized long-term negative impacts of ACEs on child development (Sun et al., 2016; Larkin et al., 2014), several studies have found a close association between ACEs and the risk of household food insecurity (Baiden et al., 2021; Chilton et al., 2015, 2017). For instance, a study of 1,518 secondary school students in Minneapolis-St. Paul, Minnesota, aged between 14.5 and 22 found that young people with one or more ACEs had higher odds of food insecurity compared to those with no ACEs. Emotional abuse and substance use by a household member were mainly associated with a higher prevalence of food insecurity (Larson et al., 2023). Another study by Baiden and colleagues analyzing the association between ACEs and household food insecurity among 17,543 children aged 0–5 in the United States found that children with at least one ACE had 1.43 times the risk of mild food insecurity and 2.33 times the risk of moderate-to-severe food insecurity. The risk of mild food insecurity was 1.5 times higher, and the risk of moderate-to-severe food insecurity was 3.96 times higher for children with two or more ACEs compared to those with no ACEs (Baiden et al., 2021).

Research based on data from the National Longitudinal Study of Adolescent to Adult Health (NLSAAH), which sampled 12,288 children and adolescents, found that ACEs were associated with food insecurity during childhood and adolescence, with a cumulative effect of ACEs linked to higher odds of experiencing food insecurity in young adulthood (Testa & Jackson, 2020). A systematic review of 10 articles further indicated greater odds of food insecurity among individuals with high ACE scores, with most studies showing a dose-response or threshold effect of higher ACEs correlating with more severe ACEs (Royer et al., 2022).

Generally, caregivers strive to meet their children's nutritional needs even if it means adult household members remain food insecure or impoverished. However, this adds significant stress on caregivers, potentially impairing their functioning. Other previous studies have found that household food insecurity is associated with a wide range of negative child outcomes in developmental, cognitive, language, health, motor, social, emotional, and behavioral domains, even in high-income countries such as the United States (Oliveira et al., 2020; Kim et al., 2020). The evidence of a strong association between exposure to adversity and household food insecurity suggests that the U.S. has a serious child health crisis. Therefore, experts on ACEs and food insecurity should work on finding solutions through integrated approaches that can address both exposure to violence and discrimination and advocate for more financial resources to enable low-income families to afford food.

The Current Study’s Theoretical Frameworks

Current literature on ACEs, child maltreatment, and poverty identifies several pathways that can lead to food insecurity (Baiden et al., 2021; Testa & Jackson, 2020; Larson et al., 2023; Clinton et al., 2023). Although these pathways are not explicitly examined in existing studies, the current research explores them using Bronfenbrenner's Ecological Systems model (Bronfenbrenner, 1979). This model posits that individual development is influenced by a series of interconnected environmental systems, ranging from immediate surroundings (e.g., family) to broader societal structures (e.g., culture), which can contribute to food insecurity. Bronfenbrenner categorized the environment into five systems: the microsystem, mezosystem, exosystem, and macrosystem (Bronfenbrenner, 1979). Both ACEs and food insecurities may be shaped by these systems, which are crucial to child development. At the micro and mezo levels, children from impoverished families may face low income, parental substance abuse, lack of education, divorce, immigration status, large family size, and single-parent households, all of which can contribute to food insecurity (Cohen et al., 2018; Melchior et al., 2009; Whitaker et al., 2006).

The link between ACEs and food insecurity could extend into adulthood. Adults with a history of childhood maltreatment, particularly sexual abuse, have higher odds of experiencing food insecurity (Wehler et al., 2004). Additionally, food insecurity in adolescents is associated with high-risk behaviors, including commercial sexual exploitation of minors (CSEC), a form of child sexual abuse (Popkin et al., 2016). At the exosystem and macrosystem levels, communities with high food insecurity may have higher rates of child abuse and other childhood adversities due to the concentration of food-insecure families with risk factors for ACEs. Community-level relationships may also arise from the contextual effects of concentrated food insecurity (Kim et al., 2023). For instance, the majority of poor communities lack resources, have poor education systems and infrastructure, high unemployment, and experience higher rates of crime, amid economic challenges, all of which may negatively affect acess to food, thus contributing to food insecurity (Vambe, 2016).

The Family Stress Model (FSM) is another important model that elucidates the direct relationship between ACEs and food insecurity through individual pathways (Conrad-Hiebner & Byram, 2020; Conger et al., 1992). The model suggests that food insecurity and the prioritization of basic necessities can create economic pressure, manifesting as ACEs, provoking family chaos, and disrupting daily life. This economic pressure increases parental distress, deteriorating family relationships (Conger et al., 1992). For instance, interparental conflicts can elevate a child's risk of exposure to domestic violence, neglect, or physical abuse (Jackson et al., 2018). Parent-child conflicts may escalate to harsh parenting and aggressive behaviors, leading to physical abuse (Helton et al., 2019). High parental stress can result in depression, dissociating parents from their caregiving role, and increasing neglect, including providing nutrition to their children, thereby heightening the risk of food insecurity (Pelton, 2015).

The Purpose of the Study

The strong association between ACEs and food insecurity across various contexts has been adequately studied (Baiden et al., 2021; Larson et al., 2023; Testa & Jackson, 2020; Royer et al., 2022; Larson et al., 2023). Despite this, there is limited evidence examining connections between ACEs and food insecurity among children from non-English-speaking households. Most non-English-speaking households in the U.S consist predominantly of immigrants, refugees, and asylum seekers (Smith et al., 2024; Salvo & Williams, 2017). Therefore, this study aims to fill this gap by extensively examining the association between parent-reported individual and cumulative ACEs and food insecurity among U.S. children in non-English-speaking households. Drawing from Bronfenbrenner's Ecological Systems (Bronfenbrenner, 1979), and Family Stress Model (Conger et al., 1992), as well as prior literature, we hypothesized a robust and significant association between parent-reported individual ACEs and food insecurity after controlling for individual, family, and community-level characteristics in the models. Simultaneously, we hypothesized that parent-reported cumulative ACEs will predict a higher likelihood of U.S. children experiencing food insecurity compared to those with no cumulative ACEs.

Data Source

Data were derived from the 2022 National Survey of Children's Health (NSCH). This was a cross-sectional, web- and paper-based survey of non-institutionalized U.S. children ages 0 to 17. The NSCH provides annual state-level and nationally representative estimates for child health and healthcare indicators. The Health Resources and Services Administration's Maternal and Child Health Bureau, within the U.S. Department of Health and Human Services, provided direction and funding for the survey, and the U.S. Census Bureau conducted the survey. Survey respondents were parents or other caregivers (hereafter referred to as "parents") familiar with the child's health and health care.

Data Collection

Data collection efforts for the 2022 NSCH occurred between July 8, 2022, and January 20, 2023. The 2022 NSCH retained a two-phase data collection approach: (1) an initial household screener to assess the presence, essential demographic characteristics, and special health care needs status of any children in the home; and (2) a substantive topical questionnaire completed by a parent or caregiver of the selected child. Participation in the 2022 NSCH was voluntary, and all personal data collected were de-identified. Data were kept private according to applicable laws, and respondents were assured confidentiality of their information during data collection process.

Sampling Procedures

The weighted overall response rate for the 2022 NSCH was 39.1%. A total of 122,0000 screener questionnaires were completed, and 67, 269 were eligible for topical questionnaire follow-up. Sampling weights were adjusted to account for nonresponse, and nonresponse bias analyses were conducted to confirm that the weight adjustments substantially reduced the magnitude of potential biases (U.S. Census Bureau, 2024). The post-stratification adjustment ensured that the estimates appropriately represented sociodemographic sub-groups. The overall sample size for the 2022 NSCH was 54,103 U.S. children surveyed nationwide. For households with multiple children, only one child was randomly selected as the survey subject. However, for this analysis, we only selected children whose parents reported coming from households where they speak Spanish and languages other than English. Therefore, the final sample size for the current study only included 4677 children in U.S households. More detailed information regarding the survey's methodology can be found elsewhere (U.S. Census Bureau, 2022).

Measures

Dependent Variable

Food security insecurity was assessed by asking the parents the question, “which of the following best describes your household's ability to afford the food you need during the past 12 months”. The responses were categorized as (1) we could always afford to eat good nutritious meals, (2) we could always afford enough to eat but not always the kind of food we should eat, (3) sometimes we could not afford enough to eat (4) Often we could not afford enough to eat. Household food insecurity was determined to be "food secure" when parents reported that they could sometimes or always afford to have enough to eat. Conversely, "food insecurity" was determined when parents reported they could sometimes or often not afford enough to eat.

Independent Variables

Adverse childhood experiences (ACEs). For ACE status, we created a composite variable based on the following eleven types of ACEs: (1) hard-to-cover basics like food or housing due to financial/economic hardship; (2) parent or guardian divorced; (3) lived with a person with alcohol/drug problem; (4) parent or guardian time in jail or prison; 5) lived with a mentally ill person; (6) witness of domestic violence; (7) victim or witness of neighbourhood violence; (8) mistreated because of race; and (9) parent or guardian died (10) mistreated because of health condition, and (11) mistreated because of sexual orientation. The distribution of children based on the types of ACEs was highly right-skewed, and only a small percentage of children (only 2.5%) had three or more ACEs. Therefore, instead of using a continuous measure of ACEs, we categorized children as those with no ACEs, one ACE, two ACEs, and three or more ACEs. Previous studies implemented similar approaches to report ACEs (Lanier et al., 2018).

Control Variables

Consistent with Bronfenbrenner's ecological systems and family stress models, we examined several control variables that were selected across the key nested domains that children occupy at the individual, family, and community levels (Assing-Murray & Lebrun-Harris, 2020; Bronfenbrenner, 1979). Control variables at the individual level included the - child's sex, age, and race/ethnicity. At the family level, the variables included were the number of children in the household, household poverty status relative to the federal poverty threshold, household education level, parental employment status, and household structure. Community-level covariates were residence (metropolitan or non-metropolitan) and neighbor conditions (yes or no). All the completed specific categorization of each variable are shown in Table 1.

Data Analysis

We first conducted descriptive analyses to obtain demographic characteristics of participants at the individual, family, and community level with food insecurity using frequencies and percentages due to the categorical nature of the variables. We further obtained the weighted prevalence estimates of ACEs using descriptive statistics. We conducted unadjusted and adjusted analyses using multivariable logistic regressions to assess the study's independent relationship between individual and cumulative ACEs with household food insecurity. We controlled for demographic and socioeconomic characteristics at the individual, family, and community levels for all the adjusted models. Six models were fitted for the food insecurity variable using nested models to assess the extent of potential confounding with ACEs. First, Model 1 was the unadjusted model for the individual ACEs, including only Individual ACEs as independent variables. Model 2 included adjustments for the individual child level (child’s sex, age, and race/ethnicity), family level (number of children in the household, household poverty status, household education, parental employment, and household structure), and community level variables (place of residence, and neighbourhood poorly kept/rundown housing) (See Table 3). Second, we fitted four models to examine cumulative ACEs associated with household food insecurity. Model 1 was the unadjusted model, which included only individual ACEs as independent variables. Model 2 included adjustments for the individual child level (sex, age, and race/ethnicity) and family level (number of children in the household, household poverty status, household education, parental employment, and household structure). Model 3 included all covariates from Model 2 and family-level covariates. Model 4 included all the covariates from model 2 (individual child level), model 3 (family level covariates), as well as community level covariates (place of residence (rural vs urban), and neighborhood poorly kept/rundown housing). Model results are reported as adjusted odds ratios and 95% confidence intervals. The odds ratios represent the independent effect of each covariate of interest on the relative odds of household food insecurity compared to the reference group. All analyses were weighted based on the survey's sampling design to produce estimates nationally representative of U.S. non-institutionalized children in 2022 and were conducted using SPSS vs 29.0.

Ethical Considerations

The current study was exempt from IRB review because it utilized existing data that were de-identified and publicly available. The Institutional Review Board (IRB) at the University of …………….. determined this study to be exempt due to the secondary nature of the data.

Descriptive Characteristics of the Participants

The survey-weighted descriptive statistics for all covariates are presented in Table 1. Out of the 4677 children from non-English speaking households, more than half were male (51.9%), White by race (57.5%), and 38.9% were between 0 and 5 years old. Regarding the family level, parents reported that 39.7% of the children came from households with at least one child, 27.5% came from households with poverty below 100%, and 45.1% had at least a college degree. The majority of the children came from families where at least one parent was employed (75.8%), 62.4% had at least two parents married, and only 4.5% reported coming from households with food insecurity. More than half, 56.8%, lived in metropolitan areas, and 9.8% lived in poorly kept neighborhoods.

The Prevalence of Parent-Reported Individual and Cumulative ACEs for U.S Children in Non-English-speaking Households

Table 2 presents the results of the prevalence of individual and cumulative ACEs. Regarding parent-reported individual ACEs, 14% experienced economic hardships, 13.7% had their parents or guardians divorced, 4.2% were mistreated because of their race, 3.2% lived with person with alcohol or drug problems, 2.7% lived with a family member with mental illness, 2.6% were victims of violence, 2.4% witnessed violence in their neighborhood, 1.8% had their parents died, 1.6% parent or guardian spent time in jail or prison, 1.3% were mistreated because of their race, and 1.1% were mistreated because of health conditions, respectively. About cumulative ACEs, 15.9% experienced at least one ACE, 4% at least two ACEs, and 2.5% at least three or more ACEs.

Association Between Parent-Reported Individual ACEs and Food Insecurity for U.S Children in Non-English-Speaking Households

Table 3 shows the results of an association between parent-reported individual ACEs and food insecurity. After controlling for covariates, children whose parents reported family encountering economic hardships (OR = 16.3, CI = 11.9–22.3); AOR = 13.2, CI = 8.74–20.1), having parents or guardians who were divorced (OR = 3.85, CI = 2.83–7.95; AOR = 2.65; CI = 1.72–4.07), and having a parent or guardian who died (OR = 4.21, CI = 2.23–7.95; AOR = 3.59, CI = 1.48–8.72) were associated with higher odds of food insecurity. However, other individual ACEs, including children whose parents reported spending time in jail or prison (OR = 3.68; CI = 1.86–7.31), victims of violence (OR = 3.85; CI = 2.22–6.68), witnessed neighborhood violence (OR = 2.68; CI = 1.41–5.10), lived with mentally ill person (OR = 2.85; CI = 1.57–5.17), lived with person with alcohol or drug problems (OR = 3.44; CI = 2.05–5.78), and were mistreated because of their health conditions (OR = 3.26; CI = 1.37–7.79) were associated with higher odds of food insecurity only in unadjusted model, but after covariate adjustment, none of these individual ACEs were associated with food insecurity. Finally, parent-reported unfair treatment due to race was not significantly associated with food insecurity before and after covariate adjustments, as evidenced in the models.

Association Between Parent-Reported Cumulative ACEs and Food Insecurity for Children in Non-English Speaking Households

Table 4 extensively examined cumulative ACEs and food insecurity for U.S. children in Non-English-speaking households. Across the four models, we observed a significant association between parent-reported cumulative ACEs and food insecurity. Notably, in model 4, after adjusting for individual, family, and community-level characteristics, we found that children whose parents reported having experienced at least one ACE (aOR = 1.98; CI = 1.17–3.38), two ACEs (aOR = 3.51; CI = 1.61–7.64), and three or more ACEs (aOR = 2.25; CI = .79–6.46) were more likely to experience food insecurity compared to children with no parent-reported cumulative ACEs.

Drawing from the lens of the Ecological Systems and Family Stress Models (Bronfenbrenner, 1977; Conger et al., 1992), this study examined the association of individual and cumulative ACEs with food insecurity among children in non-English-speaking households in the U.S. According to parental reports, only 4.5% of children experienced food insecurity, and an even smaller percentage had three or more ACEs (2.5%). Although there are numerous causes of household food insecurity, its prevalence in the U.S. is lower compared to other countries, potentially due to social safety net programs such as the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (Otten et al., 2023). These programs support low-income individuals and families in accessing nutritious food (Nestle, 2019; Nord, 2012) and have proven to be effective models for reducing food insecurity among low-income populations (Caspi et al., 2022; Kaiser et al., 2015; Rivera et al., 2019). However, financial assistance programs often fail to meet a family's typical needs. In fiscal years 2019 and 2020, the average assistance was less than $1.40 per person per meal, significantly underestimating the cost of a healthy diet (Center on Budget and Policy Priorities, 2024). Additionally, the maximum SNAP benefit amounts are uniform across the United States despite regional differences in food costs. This means they do not cover the average cost of a modestly priced meal in most regions even after the update in October 2021 (Areeba, 2021).

Poverty is an important social determinant of health that contributes to numerous child health outcomes, including those related to food insecurity (Henize et al., 2015; Assing-Murray & Lebrun-Harris, 2020). Among individual ACEs, family economic hardship (a proxy for poverty) was significantly associated with food insecurity for children in non-English-speaking households in this study. More specifically, early exposure to economic adversity is directly connected to health problems and increased risk for premature mortality in adulthood, regardless of adult's economic status (Evans, 2017; Assing-Murray & Lebrun-Harris,2020). The economic adversities may also be the barrier to gaining access to income. Previous studies have documented that low income is a primary predictor of common food insecurity often encountered in low-income families (Gutierrez, 2022; Delbiso et al., 2024; Gundersen et al., 2011; Wight et al., 2014). When income is constrained, households may be compelled to make difficult decisions, resulting in a less-than-adequate food supply, affecting children's nutritional needs (Gundersen et al., 2011; Wight et al., 2014). Additionally, we found that children of divorced parents were found to be 2.65 times more likely to experience food insecurity. It can be argued that divorce often reduces the combined income potential of parents, increasing the risk of food insecurity for the affected families. Studies have shown that children living with single parents are more susceptible to food insecurity than those living with both parents (Balistreri, 2018; Dube et al., 2003; Gundersen & Ziliak, 2015; Leitz, 2018). Single-parent households typically have a single source of income, limiting the parent's purchasing power to meet all children's dietary and nutritional needs. Moreover, children living with a single parent may lack adequate emotional and psychological support to utilize food efficiently (Kansanga, 2022; Unger et al., 1999).

Moreover, in communities characterized by high poverty rates and limited social support systems, parental loss can intensify pre-existing vulnerabilities, thereby increasing food insecurity among orphans (Munodawafa, 2017; UNICEF, 2006). Correspondingly, our findings indicate that children who have lost a parent or guardian are more likely to experience food insecurity in households where English is not the primary language. The death of primary caregivers, who often serve as the main breadwinners, results in a significant decrease in household income, making it difficult to afford adequate food. Without parents, orphans frequently lack necessary financial support and resources. Extended family members or guardians who assume responsibility for orphans may already face financial hardships, leading to additional strain and insufficient resources for food. The loss of parents disrupts household structure and stability, impeding the ability to procure and prepare food, which can result in inconsistent meals and poor nutrition. Additionally, the trauma associated with parental loss can adversely affect an orphan's mental health, complicating the management of daily activities, including securing food.

Other ACEs, such as having a parent or guardian incarcerated, being a victim of violence, witnessing neighborhood violence, living with a mentally ill person, living with someone who has alcohol or drug problems, and experiencing mistreatment due to a health condition, demonstrated weaker associations with food insecurity. These factors only predicted food insecurity before other factors were considered, limiting our ability to draw firm conclusions. These findings are consistent with a prior study by Testa & Jackson, (2020) which showed that food insecurity ranged from 1.29 for community violence to 1.68 for parental incarceration when accounting for demographic factors and potential mediators. However, physical neglect and exposure to suicide were not associated with food insecurity (Testa & Jackson, 2020). Despite this, these ACEs remain observable risk factors contributing to food insecurity. Parental relationships often dissolve during incarceration, increasing the likelihood of food insecurity due to the loss of shared earnings (Geller & Franklin, 2014; Western, 2006). Economic hardships continue beyond incarceration, as ex-prisoners face labor market challenges, making it difficult to provide food for their children (Davison et al., 2019; Schwartz-Soicher et al., 2011; Turney, 2015). Additionally, the overrepresentation of people of color in the criminal justice system means that many children experience food insecurity due to the absence of their parents (Kovera, 2019; Nellis, 2016). Prior research has also demonstrated strong associations between parental mental health problems, exposure to violence, and food insecurity, even in high-SES households (Larson et al., 2023; Wade et al., 2014).

Most importantly, we found support for our hypothesis that, after controlling for individual, family and communty level factors, there would be a significant association between ACEs and food insecurity for children in non-English-speaking households. Notably, children with cumulative ACE scores of three or more had 2.3 times were more likely to be food insecure. This finding supports previous research indicating that the accumulation of ACEs is associated with higher odds of food insecurity (Jackson et al., 2019; Baiden et al., 2021; Chilton et al., 2015, 2017; Testa & Jackson, 2020; Royer et al., 2022). Although the previous studies primary focus were not on children in non-English-speaking households in the U.S., the findings are relevant as they confirm the link between cumulative ACEs and food insecurity among adolescents and adults in the U.S (Larson et al., 2023; Testa & Jackson, 2020). Therefore, this study makes a significant contribution to knowledge that ACEs are no doubt the significant contributing risk factors to household food insecurity, particularly for vulnerable children anf their fmailieis in non-English speaking households.

Implications for the Study

Our study unequivocally links both individual and cumulative Adverse Childhood Experiences (ACEs) to food insecurity among children in non-English-speaking households in the United States. The findings underscore the necessity of understanding the interconnectedness of ACEs to food insecurity so as to design interventions that better promote health equity for these children and their families. Prior studies have shown that the experience of trauma is a common thread linking ACEs and food insecurity (Roye et al., 2022). This critical insight, reinforced by our research, paves the way for more effective interventions.

Addressing this issue requires comprehensive strategies. The INSPIRES framework (World Health Organization, 2016), supported by robust evidence, outlines several strategies for mitigating and preventing violence against children across various settings. These strategies include altering norms and values, creating safe environments, supporting parents and caregivers, economic empowerment, providing response and support services, and enhancing education and life skills (World Health Organization, 2016; Chipalo, 2023). Economic empowerment is particularly vital in alleviating both ACEs and the burden of food insecurity in non-English-speaking households. For example, public assistance programs such as Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) can provide crucial support to low-income families. Research indicates that trauma-informed peer support programming can reduce economic and food insecurity, as well as depression associated with trauma (Phojanakong et al., 2020).

Economic empowerment can alleviate family tension and nutritional struggles, especially in predominantly immigrant non-English-speaking households. This should be paired with long-term approaches to create sustained support systems rather than temporary aid.

Furthermore, children in non-English-speaking households, particularly immigrants or refugees, face additional barriers such as discrimination, stigma, and challenges related to assimilation, education, and employment—potential forms of ACEs that affect both children and their parents. Addressing these barriers is crucial. Social policies aimed at addressing food insecurity and food access must consider the unique cultural, spatial, and other needs of non-English-speaking subgroups, which can exacerbate ACEs and increase the risk of food insecurity. The push for greater disaggregation of racial and ethnic groups is essential for accurately identifying and addressing disparities in food insecurity and other health dimensions, including ACEs. Future policies should recognize the distinct needs of non-English-speaking subgroups. Finally, future studies should focus on understanding the mechanisms through which ACEs negatively impact food insecurity at both individual and community levels, particularly for children from non-English-speaking households. Attention should be given to each distinct cultural group in the United States to develop targeted and effective interventions.

Limitations of the Study

There are some limitations worth highlighting for this study. Many of the limitations resulted from the fact that this was a cross-sectional study that used secondary data. Some of the most relevant variables were unavailable in the dataset, and some values were suppressed to ensure the confidentiality and anonymity of the participants. For instance, the age of exposure to ACEs and frequency of exposure to different ACEs were not available in the data and thus not captured in this study. One of the most severe forms of ACEs, such as sexual violence, was not included on the list of questions, and sexual orientation received lower response rates. Some control variables, even the outcome variable (food insecurity), can be considered ACEs. For example, household poverty ratio and single-mother parenting have been considered ACEs in previous studies. Before including the variables, we didn't check for bivariate correlations between all variables to identify potential multicollinearity. Therefore, there is the possibility that there is a higher correlation between some of the independent and control variables, such as economic hardship, household poverty ratio, food insecurity, and many others, which could pose methodological issues. Finally, the questions were based on parent reports as opposed to children, so there is a possibility of potential bias, and they may not represent children's views themselves. Despite several limitations, the study provides valuable insight into understanding the association between parent-reported ACEs and food insecurity for children in Non-English-speaking households using nationally representative data. Thus, this study makes a significant contribution to the large body of knowledge relative to ACEs and food insecurity.

This study indicates that individual and cumulative Adverse Childhood Experiences (ACEs) significantly contribute to food insecurity among children in non-English-speaking households. We identified a dose-response relationship between ACEs and food insecurity, even after adjusting for individual, family, and community factors. These findings underscore the need for further research to prevent and mitigate ACEs, which are key risk factors for food insecurity in these families. Preventing ACEs during childhood is crucial to reducing their harmful effects on child development and food security. Interventions should integrate approaches addressing ACE exposure, especially among non-English-speaking families, violence, discrimination, and financial challenges. Strengthening economic support through programs like SNAP and WIC can help low-income, non-English-speaking families afford food. Future research should focus on early interventions to build social and emotional support networks for at-risk families and address the stigma associated with government assistance programs.

Acknowledgments

The author(s) would like to acknowledge CDC for making VACS data publicly available.

Declaration of Conflicting Interests

The author declared a potential conflict of interest (e.g., a financial relationship with the commercial organizations or products discussed in this article) as follows: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Funding

The author(s) of this study did not receive any funding for this study

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Table 1.Sample Characteristics of Food Security Across Individual, Family, and Community Characteristics Levels for Children in Non-English Speaking Households (N=4677)

Variables	N	%
Individual Level
Child’s sex
Male	2426	51.9
Female	2251	48.1
Child’s age (years)
0-5	1819	38.9
6-11	1258	26.9
12-17	1600	34.2
Child’s race/ethnicity
White alone	2689	57.5
Black/African American	262	5.6
Other	1726	36.9
Family Level
Number of children in the household
1	1859	39.7
2	1811	38.7
3	670	14.3
4	337	7.2
Household poverty status
Below 100%	1284	27.5
100 - 199%	1195	25.6
200 - 399%	1161	24.8
400% or above	1037	22.2
Household education level
Less than high school	754	16.1
High school	1019	21.8
Some college or associate degree	797	17.0
College degree	2107	45.1
Parental employment (last 12 months)
At least one parent is employed	2629	75.8
No parents employed	841	24.2
Household structure
Two parents married	2787	62.4
Two parents, not married	336	7.5
Single mother	811	18.2
Other family type	533	11.9
Food Insecurity
Can afford food	4226	95.5
Can’t afford food	199	4.5
Community Level
Place of residence
Non-metropolitan	1919	43.2
Metropolitan	2526	56.8
Neighborhood poorly kept/rundown housing
No	3967	90.2
Yes	432	9.8

N= weighted frequencies, and % = weighted percentage of children, ACEs = Adverse childhood experiences

Table 2. Prevalence of Parent-Reported Individual and Cumulative ACEs for Children in Non-English Speaking Household (n=4677)

Variables	N	%
Individual ACEs
Family economic hardship
No	3872	86.0
Yes	628	14.0
Parent or guardian divorced
No	3744	86.3
Yes	593	13.7
The parent or guardian died
No	4260	98.2
Yes	76	1.8
Parent or guardian spent time in jail/prison
No	4259	98.4
Yes	70	1.6
Victim of violence
No	4208	97.4
Yes	111	2.6
Witnessed neighborhood violence
No	4223	97.6
Yes	102	2.4
Lived with a mentally ill person
No	4201	97.3
Yes	116	2.7
Lived with a person with alcohol/drug problems
No	4184	96.8
Yes	138	3.2
Mistreated because of race
No	4132	95.8
Yes	182	4.2
Mistreated because of health condition
No	4283	98.9
Yes	46	1.1
Mistreated because of sexual orientation
No	2595	98.7
Yes	34	1.3
Cumulative ACEs
No ACEs	3381	77.5
1 ACE	696	15.9
2 ACEs	176	4.0
Three or more ACEs	111	2.5

N= weighted frequencies, and % = weighted percentage of children

Table 3. Association Between Parent-reported Individual ACEs and Food Insecurity for Children in the U.S from Non-English Speaking Households

	Model 1	Model 2
Variables	OR (95% CI)	aOR (95% CI)
Family economic hardship
No	Ref	Ref
Yes	16.29 (11.89 – 22.30)***	13.24 (8.74 -20.07)***
Parent or guardian divorced.
No	Ref	Ref
Yes	3.85 (2.83 – 5.25)***	2.65 (1.72 – 4.07)***
The parent or guardian died.
No	Ref	Ref
Yes	4.21 (2.23 -7.95)***	3.59 (1.48 – 8.72)**
Parents or guardians spend time in jail/prison.
No	Ref	Ref
Yes	3.68 (1.86 – 7.31)***	.89 (.33 – 2.44)
Victim of violence
No	Ref	Ref
Yes	3.85 (2.22 – 6.68)***	1.52 (.60 – 3.83)
Witnessed neighborhood violence
No	Ref	Ref
Yes	2.68 (1.41 – 5.10)**	.79 (.30 – 2.09)
Lived with a mentally ill person
No	Ref	Ref
Yes	2.85 (1.57 – 5.17)***	.27 (.56 – 1.55)
Lived with a person with alcohol/drug problems
No	Ref	Ref
Yes	3.44 (2.05 -5.78)***	1.74 (.75 - 4.04)
Mistreated because of race
No	Ref	Ref
Yes	1.40 (.75 – 2.63)	1.51 (.68 – 3.37)
Mistreated because of health condition
No	Ref	Ref
Yes	3.26 (1.37 – 7.79)**	1.85 (.52 – 6.61)
Mistreated because of sexual orientation
No	Ref	Ref
Yes	x	x

*= P <.05, **= P <.01, ***= P <.001, Model 1 = unadjusted bivariate logistic was performed between ACEs and food insecurity, Model 2 = adjusted for individual level, Model 3 = adjusted individual and family level characteristics, Model 4 = adjusted for individual, family, and community level characteristics. CI= Confidence interval, OR = Odds ratio, aOR= Adjusted odd ratios, and X= was omitted from the analysis due to lower response rates.

Table 4. Association between Cumulative ACEs and Food Insecurity for Children in non-English-speaking U.S Households

Variables	Model 1	Model 2	Model 3	Model 4
ACEs	OR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
No ACEs	Ref	Ref	Ref	Ref
1 ACE	2.99 (2.13 – 4.18)***	2.89 (2.04 – 4.09)***	2.27 (1.37 – 3.76)**	1.98 (1.17 – 3.38)*
2 ACEs	6.07 (3.84 – 9.59)***	5.93 (3.70 – 9.49)***	3.56 (1.67 – 7.58)***	3.51 (1.61 – 7.64)**
3 or more ACEs	4.04 (2.15 – 7.62)***	4.20 (2.20 -8.01)***	3.44 (1.32 – 8.94)*	2.25 (.79 – 6.46)

*= P <.05, **= P <.01, ***= P <.001, Model 1 = unadjusted bivariate logistic was performed between ACEs and homelessness, Model 2 = adjusted for individual level, Model 3 = adjusted individual and family level characteristics, Model 4 = adjusted for individual, family, and community level characteristics. CI= Confidence interval, OR = Odds ratio, aOR= Adjusted odd ratios

The authors declare no competing interests.

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Parent-Reported Adverse Childhood Experiences (ACEs) and Food Insecurity Among Children in Non-English-Speaking Households in the United States

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Abstract

Introduction

Adverse Childhood Experiences and Food Insecurity

The Current Study’s Theoretical Frameworks

The Purpose of the Study

Methods

Data Source

Data Collection

Sampling Procedures

Measures

Dependent Variable

Independent Variables

Control Variables

Data Analysis

Ethical Considerations

Results

Descriptive Characteristics of the Participants

The Prevalence of Parent-Reported Individual and Cumulative ACEs for U.S Children in Non-English-speaking Households

Association Between Parent-Reported Individual ACEs and Food Insecurity for U.S Children in Non-English-Speaking Households

Association Between Parent-Reported Cumulative ACEs and Food Insecurity for Children in Non-English Speaking Households

Discussion

Implications for the Study

Limitations of the Study

Conclusion

Declarations

References

Tables

Additional Declarations

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