Date of Award

Fall 2019

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Elizabeth Crouch


Adult exposure to adverse childhood experiences (ACEs) is common in the U.S., with over half of adults reporting exposure to at least one ACE. Childhood trauma is associated with risk factors for premature death, disability, poor physical and mental health, and lower quality of life in adults. Traumatic experiences also influence parenting behaviors later in life, placing offspring at an increased risk of ACE exposure. Few studies have explored the intergenerational effects of ACEs on the health and well-being of offspring. This study sought to identify whether associations existed between caregiver ACE exposures and emergency department (ED) utilization for sick care (Study 1) and depression and anxiety (Study 2) in children. The effects of race and rural location were also explored.

Two surveys from 2014-2016 were used to assess these relationships – the SC Behavioral Risk Factor Surveillance System survey and Children Health Assessment Survey. The linked dataset included 2696 parent-child dyads. After excluding observations with missing data on study variables, the sample size was 2,205 for Study 1. Study 2 also excluded children under age 8, as no clinical guidelines on the assessment of depression/anxiety exist for children this age, bringing that sample size to 1,515.

In Study 1, 24% of caregivers were exposed to ≥4 ACEs; however, in the fully- adjusted model no association between caregiver ACE status and child ED utilization for sick care was found, except among Black caregivers with ≥4 ACE exposures, as their children had 0.41 lower odds of seeking sick care from the ED compared to White caregivers with no ACEs.

In Study 2, 23% of caregivers had been exposed to ≥4 ACEs and 29% of caregivers reported having depression/anxiety; however, no association between caregiver ACE status and depression/anxiety in children was found. Notably, 6% of children had depression/anxiety and 31% of caregivers did not know whether their child had depression/anxiety. Consistent with prior research, more children with depression/anxiety lived with caregivers exposed to four or more ACEs compared to children without depression/anxiety.

Implications of these findings and recommendations are presented in Chapters 4 and 5, respectively.

Available for download on Thursday, December 16, 2021