How do ACEs look different amongst different races ethnicities?
ACEs stand for Adverse Childhood Experiences which include instances of physical and emotional abuse, neglect, caregiver mental illness, and household violence. ACEs are common across socioeconomic groups, with more than two-thirds of the population having experienced at least one ACE. [1]
A study using U.S. Census data found that ACEs are not experienced by children of different races and ethnicities equally. It was found that across different regions in the U.S., the prevalence of ACEs is consistently lowest among Asian non-Hispanic children with an average prevalence of 23%. [2] However, this lack of reported prevalence has led to the health consequences of ACEs amongst Asian American subgroups being understudied and poorly represented.
What are the Health Inequities seen in the South Asian Community?
Regarding the existing studies on ACEs in Asian Americans, the major caveat is that the various Asian participants tend to be grouped into a single, heterogeneous group, which has led to the prevention of discovering meaningful differences amongst the distinct Asian subpopulations. [4] In a specific field like ACEs, where the experience originates from a familial setting which varies vastly with culture, language, and ancestry, obscuring such differences will hinder meaningful results. Thus it is important to study the health consequences of ACEs in diverse ethnic groups, disaggregating the Asian subgroups to bridge this gap.
Health Inequalities in South Asian Americans have been overlooked historically as they have largely been stereotyped as a model minority with favorable characteristics. This has led to them receiving lower rates of health screenings, an increased risk for diabetes, and overall poor illness monitoring. [5] It was also found that in comparison to their White peers, South Asian populations exhibit heightened physical symptoms in response to psychological and emotional distress. [6] It was also found that expressing negative emotions has higher physiological consequences and stress responses amongst South Asians, which is associated with emotional dysregulation seen in those with ACEs. [7] Finally, the cultural and religious values that are the backbone of South Asian communities are a source of familial conflict and personal distress, heightening the prevalence of ACEs. [8] Indian culture highly hinges on interpersonal harmony, and thus the expression of negative emotions and outbursts often lead to familial embarrassment and contention between children and their parents. [10]
What do we currently know about ACEs in the South Asian Community?
A study found that around half the sample reported experiencing greater than 1 ACE and 26.9% reported more than three ACEs. The most prevalent ACEs were Emotional abuse (26.9%), emotional neglect (24.6%), and physical abuse (19.2%). The finding that ACEs are significantly associated with negative health, was corroborated with the finding that 94.3% of the high ACE group had more than one previously diagnosed medical condition. [5] The findings also agree with preliminary evidence that anger expression is particularly toxic to the health of Asian American populations. [10]
Similarities were also observed in the ACE patterns from South Asian Americans and South Asians from India, highlighting how culture influences the prevalence of ACEs through generations of migrations. [9] These findings emphasize the need for regular screening and intervention in the South Asian community to combat ACE’s impact on physical health.
What further Research can be done from here?
A lot of work still needs to be done to address the ACE disparity amongst ethnic minority groups. Future studies need to look into the effects of family dynamics and cultural barriers on the ACE-health relationship. Since it was found that ethnic minority groups may manifest physical health consequences earlier than white peers, regular screening is important.
Research should focus on disaggregating data on Asian American subgroups, which will allow for a more nuanced understanding of cultural, linguistic, and ancestral differences in the manifestation of ACEs. It is also important to understand the family dynamics that contribute to emotional regulation in different Asian American communities by conducting a longitudinal study.
How can we Involve the Community and Policymakers?
Researchers, community organizations, and healthcare providers must collaborate to design culturally sensitive interventions and effective support strategies. Here are some resources for AAPI Mental Health.
Daya is a South Asian organization based out of Texas that supports South Asian survivors of domestic and sexual violence. They provide culturally specific services and educate the community to end the cycle of abuse. Raksha is another organization based out of Georgia that provides confidential support services, education, and advocacy to the South Asian community.
There are other organizations doing notable work for the Asian American communities. National Asian American Pacific Islander Mental Health Association is a nationwide directory of mental health services tailored to Asian American, Native Hawaiian, and Pacific Islander communities. Erasing Shame Podcast is a volunteer-run platform addressing shame through open discussions on holistic well-being and living for Asian Americans. Stop Stigma Together is a collaborative efforts across 14 states to combat stigma around mental health and substance use in Asian American and Pacific Islander communities.
Families and Caregivers can also educate themselves on ACEs and effective coping strategies to create a supportive environment for children at home. By openly discussing ACEs within and amongst the family and household setting, individuals can promote understanding and resilience among children at a younger age.
Policies should also be made to promote diversity and inclusion in healthcare settings to ensure that healthcare professionals are trained to recognize and respond to unique cultural and linguistic barriers that may affect the reporting of ACEs in Asian communities.
References:
What are aces? and how do they relate to toxic stress?. Center on the Developing Child at Harvard University. (2020, October 30).
Sacks, V., & Murphey, D. (2018, February 12). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity -ChildTrends.
Forster, M., Grigsby, T. J., Rogers, C. J., & Benjamin, S. M. (2018). The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students. Addictive behaviors, 76, 298–304. https://doi.org/10.1016/j.addbeh.2017.08.037
DeLisi, M., Alcala, J., Kusow, A., Hochstetler, A., Heirigs, M. H., Caudill, J. W., Trulson, C. R., & Baglivio, M. T. (2017). Adverse Childhood Experiences, Commitment Offense, and Race/Ethnicity: Are the Effects Crime-, Race-, and Ethnicity-Specific?. International journal of environmental research and public health, 14(3), 331. https://doi.org/10.3390/ijerph14030331
Santoro, A. F., Suchday, S., Robbins, R. N., Benkhoukha, A., & Zemon, V. (2021). Childhood adversity and physical health among Asian Indian emerging adults in the United States: Exploring disease-specific vulnerabilities and the role of anger. Psychological trauma : theory, research, practice and policy, 13(2), 214–222. https://doi.org/10.1037/tra0000942
Chandra, R. M., Arora, L., Mehta, U. M., Asnaani, A., & Radhakrishnan, R. (2016). Asian Indians in America: The influence of values and culture on mental health. Asian journal of psychiatry, 22, 202–209. https://doi.org/10.1016/j.ajp.2015.09.011
Suchday, S., & Larkin, K. T. (2004). Psychophysiological responses to anger provocation among Asian Indian and White men. International journal of behavioral medicine, 11(2), 71–80. https://doi.org/10.1207/s15327558ijbm1102_2
Farver, J. A., Narang, S. K., & Bhadha, B. R. (2002). East meets west: ethnic identity, acculturation, and conflict in Asian Indian families. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 16(3), 338–350. https://doi.org/10.1037//0893-3200.16.3.338
Santoro AF, Suchday S, Benkhoukha A, Ramanayake N, & Kapur S (2016). Adverse childhood experiences and religiosity/spirituality in emerging adolescents in India. Psychology of Religion and Spirituality, 8(3), 185–194. 10.1037/rel0000038
Suchday, S., & Larkin, K. T. (2004). Psychophysiological responses to anger provocation among Asian Indian and White men. International journal of behavioral medicine, 11(2), 71–80. https://doi.org/10.1207/s15327558ijbm1102_2
Author Bio:
Maithree Venkatesan is an MPH candidate at the Rollins School of Public Health, Emory University, completing her degree in Healthcare Management. Before entering graduate school, she completed her M.Sc. in Biological Sciences at BITS Pilani, India. Maithree is passionate about working with children on the spectrum, and completed her thesis at the University of California, San Diego specializing in methods for Early Detection of Autism. With an interest in disability studies, she hopes to make an impact in increasing access to tailored interventions for marginalized communities.