Beyond Cumulative Risk: Gender-Specific Latent Class Patterns of Adverse Childhood Experiences and Systemic Inequities in Black Americans.

The effects of adverse childhood experiences (ACEs) are recognized as a key determinant of lifelong health and are often operationalized as a cumulative risk. Representing ACEs by the number of adversities reported limits our capability to detect patterns of ACE severity and co-occurrence. We explored patterns of ACEs among women and men using latent variable modeling. Twenty-one states included an optional ACE module in the 2019 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random digit dial telephone survey of adults. Data were from 14,685 Black adults on nine ACEs topics, including physical, emotional and sexual abuse, household alcohol use, drug use, mental illness, incarceration, divorce and partner violence. The weighting and analysis were conducted in March 2023. The nine survey questions were dichotomized to indicate exposure and two unwanted touching sexual abuse indicators were combined to form 10 ACE indicators. Latent class analysis was used to identify underlying patterns of ACEs. Different patterns of ACE exposure were linked to race and gender societal experiences for women and men. ACEs clustered into three classes for women and four classes for men. Women were classified as having high adversity with two classes distinguished by the endorsement of sexual abuse (13% and 17%). Men were classified as having above average probabilities of emotional and physical abuse (21%) and high adversity without sexual abuse (9%) and with sexual abuse (4%). We found distinct heterogeneous latent class patterns of childhood adversity among Black adults. The identification of gender-stratified ACE clusters provides empirical support to move beyond cumulative ACE scoring; quantifying ACEs in clusters is a better way to address the gendered societal norms, and cultural contexts shaping adversity exposure and resilience.