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Race and Sex Differences in Adverse Childhood Experiences among Asian/Pacific Islander College Students

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Title: Race and Sex Differences in Adverse Childhood Experiences among Asian/Pacific Islander College Students
Language: English
Authors: Sieben, Andrew, Lust, Katherine, Crose, Ainslee, Renner, Lynette M., Nguyen, Ruby H. N.
Source: Journal of American College Health. 2021 69(4):353-360.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 8
Publication Date: 2021
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Asian American Students, Pacific Islanders, White Students, Racial Differences, College Students, Incidence, Experience, Child Abuse, Rape, Gender Differences, Sexual Abuse, Student Characteristics, Trauma, Family Environment, Violence
Geographic Terms: Minnesota
DOI: 10.1080/07448481.2019.1677671
ISSN: 0744-8481
Abstract: Objective: Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.
Abstractor: As Provided
Entry Date: 2021
Accession Number: EJ1297048
Database: ERIC
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  Value: <anid>AN0150768975;acl01may.21;2021Jun10.02:20;v2.2.500</anid> <title id="AN0150768975-1">Race and sex differences in adverse childhood experiences among Asian/Pacific Islander college students </title> <p>Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.</p> <p>Keywords: Adverse childhood experiences; Asian; child abuse; college student</p> <hd id="AN0150768975-2">Introduction</hd> <p>Over the past two decades, numerous researchers have shown that adverse childhood experiences (ACEs) are related to negative physical, mental, and behavioral health outcomes later in life.[[<reflink idref="bib1" id="ref1">1</reflink>]] This growing body of literature was initiated by Felitti and colleagues in 1998 in which they described the relationship between a list of ACEs, which included forms of child abuse/neglect and household dysfunction, and adult risk behaviors and health outcomes.[<reflink idref="bib8" id="ref2">8</reflink>] Researchers have continued to assess the effect of ACEs on the development of various physiological and psychopathologies, in addition to expanding the ACE list to consider additional adverse experiences (such as the death of a loved one, economic hardship, injury, and relocation frequency).[<reflink idref="bib2" id="ref3">2</reflink>],[[<reflink idref="bib9" id="ref4">9</reflink>]] These findings have generally shown a connection between traumatic events encountered during a child's development and poor health outcomes.[<reflink idref="bib5" id="ref5">5</reflink>],[<reflink idref="bib12" id="ref6">12</reflink>]</p> <p>ACEs are associated with a wide variety of negative physical, mental, and behavioral health outcomes that affect individuals and their communities. ACEs have been linked with mental health conditions such as depression, attempts at suicide, anxiety disorders, insomnia, and posttraumatic stress disorders, as well as increased rates of tobacco use, substance abuse, and risky sexual behaviors.[<reflink idref="bib1" id="ref7">1</reflink>],[<reflink idref="bib5" id="ref8">5</reflink>],[<reflink idref="bib13" id="ref9">13</reflink>],[<reflink idref="bib14" id="ref10">14</reflink>] ACEs are also associated with a number of physical health conditions that develop later in an individual's life, including cardiovascular disease, stroke, obesity, chronic obstructive pulmonary disease, and autoimmune diseases.[<reflink idref="bib3" id="ref11">3</reflink>],[<reflink idref="bib5" id="ref12">5</reflink>],[<reflink idref="bib12" id="ref13">12</reflink>],[<reflink idref="bib13" id="ref14">13</reflink>] Additionally, childhood maltreatment has been linked with an increased risk of intergenerational perpetuation of ACEs, although not all parents who were exposed to ACEs continue this cycle.[[<reflink idref="bib15" id="ref15">15</reflink>]]</p> <p>These negative health outcomes are thought to be mediated in part by a dysregulation of neurological stress responses and impaired neural development caused by chronic exposure to traumatic experiences.[<reflink idref="bib5" id="ref16">5</reflink>],[<reflink idref="bib12" id="ref17">12</reflink>] Physiologic responses to stress involve the activation of the hypothalamic-pituitary-adrenomedullary (HPA) axis and the sympathetic nervous system. When a child encounters an adverse experience, these neuroendocrine systems work in conjunction to release cortisol, adrenaline, and norepinephrine that stimulate a "fight-or-flight" response.[<reflink idref="bib3" id="ref18">3</reflink>],[<reflink idref="bib23" id="ref19">23</reflink>] Elevated cortisol levels stimulate a negative feedback loop via the parasympathetic nervous system, which in turn modulates the stress response by decreasing hormone levels to normal. However, exposure to frequent or intense adverse situations, so-called <emph>toxic stress</emph>, can result in sustained activation of the HPA and sympathetic nervous system, thereby extending exposure to elevated hormone levels that subsequently lead to dysregulation of the neuromodulary system and inflicting damage on neural function and structure.[<reflink idref="bib3" id="ref20">3</reflink>],[<reflink idref="bib23" id="ref21">23</reflink>],[<reflink idref="bib24" id="ref22">24</reflink>] Such physiological damage is thought to impair mood control, promote hyperactivity of anxiety responses, and reduce neurogenesis, thereby hindering normal development of the nervous system during childhood.[<reflink idref="bib25" id="ref23">25</reflink>],[<reflink idref="bib26" id="ref24">26</reflink>]</p> <p>ACEs appear to be prevalent in many populations. In 1998, Felitti and colleagues found that more than 52% of adult study participants experienced one or more ACEs. Researchers conducting subsequent surveys, both national and regional, report similar findings, with more than 60% of participants experiencing at least one ACE and more than 10% of participants experiencing four or more ACEs in their lifetime.[[<reflink idref="bib27" id="ref25">27</reflink>]] Yet, despite the high prevalence and cooccurrence of ACEs in the general population, there is a dearth of information about ACE prevalence among racial/ethnic minorities, especially in Asian and Pacific Islander populations. Current knowledge of ACE prevalence among minority groups suffers from the same limitations as other health and behavioral studies, namely, aggregation of multiple racial/ethnic groups into one broad category (such as "White, Black, and Other"). Many of the national studies fail to report the prevalence of individual ACEs among Asians/Pacific Islanders, either assessing total ACE exposure or grouping Asians/Pacific Islanders with other racial and ethnic groups.[<reflink idref="bib8" id="ref26">8</reflink>],[<reflink idref="bib27" id="ref27">27</reflink>] When total ACE exposure was compared among racial/ethnic groups, Asians generally had lower exposure to ACEs relative to other races and ethnicities.[<reflink idref="bib8" id="ref28">8</reflink>],[<reflink idref="bib28" id="ref29">28</reflink>] If heterogeneities exist in total ACE exposure among certain racial/ethnic groups, differences might also exist among individual ACE exposure that, in turn, give rise to specific problems that affect the community and require tailored responses. These differences may arise due to a myriad of factors, including unique sets of cultural norms that influence the distribution and reporting of those ACEs compared to other racial/ethnic groups.</p> <p>Data from the National Child Abuse and Neglect Data System (NCANDS) shows that Asians have the lowest prevalence of child maltreatment (e.g., child physical, emotional, sexual abuse and neglect) compared to other racial/ethnic groups.[<reflink idref="bib31" id="ref30">31</reflink>] Researchers who specifically investigated child maltreatment in Asian communities found that, when comparing different types of maltreatment, Asian populations generally exhibited higher rates of physical child abuse and lower rates of child neglect and sexual abuse relative to other racial/ethnic populations.[[<reflink idref="bib32" id="ref31">32</reflink>]] Meston et al. reported a higher rate of physical abuse and lower rate of sexual abuse among Asian college students in Canada, relative to non-Asians.[<reflink idref="bib32" id="ref32">32</reflink>] Researchers from two studies based on child maltreatment investigations in Los Angeles Asian immigrant populations identified higher rates of physical abuse and lower rates of neglect relative to other racial/ethnic groups.[<reflink idref="bib34" id="ref33">34</reflink>],[<reflink idref="bib35" id="ref34">35</reflink>] Pelczarski and Kemp found similar results when studying Asian/Pacific Islander children referred to child protective services in Washington state.[<reflink idref="bib37" id="ref35">37</reflink>]</p> <p>Although these findings provide important insights, a number of limitations to current knowledge about ACEs in Asian/Pacific Islander communities remain. First, these studies only provide information on child maltreatment as defined by physical, emotional, sexual abuse and neglect, and do not consider the broader range of traumatic experiences that constitute ACEs. Second, much of the current knowledge about child maltreatment among Asians/Pacific Islanders is based on data from child protection cases among unrepresentative samples of Asian communities and is constrained by small sample sizes, thereby limiting generalizability to other Asian/Pacific Islander populations. Third, samples based on child protective cases only offer a snapshot into the types of adversity a child experiences at a given point in time and may fail to detect adverse experiences that occur before or after the case report.</p> <p>Studying ACE exposure among males and females 18 years and older can provide a more comprehensive summary of the adversity individuals experience throughout childhood. Since the effect of ACEs is primarily mediated by sustained exposure during childhood development, characterizing ACEs among 18- to 24-year-olds provides an immediate picture of the effect ACEs have following critical periods of development. One population that can serve as an effective study group in this regard is college students.</p> <p>College students are likely to exhibit the strongest recall of ACEs given that these events would have occurred more recently in the course of their lives. Perhaps more importantly, understanding the prevalence of ACEs among college students offers an opportunity to implement interventions that reduce or ameliorate the effects of ACEs on adult health. College students may be a receptive population to intervention efforts and may have access to their institution's healthcare resources. By gaining insight into the prevalence of ACEs among college-aged students, prevention efforts can be better established to impede the development of chronic health conditions and to interrupt cycles that extend the effect of ACEs to future generations. Thus, characterizing ACEs among college students can improve our ability to prioritize effective intervention efforts, and ultimately prevent and abate the harm that ACEs produce.</p> <p>The aim of this study was to improve our understanding of the prevalence of individual ACEs among Asians/Pacific Islanders, relative to Whites, in Minnesota's college student population. We hypothesized that Asians/Pacific Islanders would report similar or lower overall levels of ACE exposure relative to Whites, but for individual ACEs, Asians/Pacific Islanders would report higher exposure to physical abuse and lower exposure to sexual abuse than Whites. Our aim was to assess racial and sex differences in ACE distribution to better guide prevention and intervention efforts for college students and the broader community.</p> <hd id="AN0150768975-3">Methods</hd> <p></p> <hd id="AN0150768975-4">College health survey</hd> <p>Data for this study were obtained from the 2015 College Student Health Survey (CSHS). The CSHS is a cross-sectional surveillance study administered by Boynton Health at the University of Minnesota aimed at assessing the health status and behaviors of Minnesota's postsecondary students. Originally created in 1995 at the University of Minnesota, items in the CSHS were compared to national surveillance systems to confirm instrument validity and accuracy.[<reflink idref="bib38" id="ref36">38</reflink>] Undergraduate and graduate students from a mix of 17 public and private, 2- and 4-year postsecondary institutions in Minnesota were randomly selected from enrollment rosters and invited to participate in the online survey via email. Reminder emails were sent up to six times to students who had not opened the survey, and students received a postcard during the second week of the survey to encourage participation. Students were informed that upon completion of the survey they could enter into a lottery drawing for a monetary gift card. Of the 38,648 students invited in 2015, 12,220 completed the online survey (31.6% participation). Additional information regarding the survey methodology can be found at https://boynton.umn.edu/surveys and has previously been described in detail.[<reflink idref="bib39" id="ref37">39</reflink>],[<reflink idref="bib40" id="ref38">40</reflink>] The University of Minnesota Institutional Review Board (IRB #0712S2294) approved all survey methods and exempted these de-identified secondary analyses from further human subjects review.</p> <hd id="AN0150768975-5">Assessment of adverse childhood experiences (ACEs)</hd> <p>Students answered a series of 11 questions about adverse experiences they had undergone before the age of 18. The ACEs assessed in the survey were: mental illness (household), alcohol abuse (household), drug abuse (household), incarcerated family member, parents separated/divorced, observation of domestic violence, experiencing physical abuse, experiencing emotional abuse, being touched sexually, being forced to touch someone sexually, and rape. Respondents were asked to recall either presence/absence of events (yes, no, don't know/not sure) or a categorical measure of frequency (never, once, more than once). Each ACE exposure was evaluated as a binary variable (exposed, unexposed); students who responded as having ever experiencing an ACE (e.g., once or more than once) were grouped and considered exposed. Students who were unsure about experiencing ACE events were not included in the analyses.</p> <hd id="AN0150768975-6">Demographic variables</hd> <p>Only individuals who self-identified as Asian, Pacific Islander, or non-Hispanic White were included in our analyses. Respondents who identified as Asian-only or Pacific Islander-only were grouped as Asians/Pacific Islanders. Those who identified as White-only and did not identify as Hispanic were considered White. Respondents who identified as a mix of races were excluded from all analyses due to insufficient sample size. All analyses were conducted using data from students who identified as either female or male. Respondents who identified as a sex other than female or male were excluded from analysis due to insufficient sample size. Students also reported sexual orientation as heterosexual or straight, gay or lesbian, bisexual, not sure yet, unsure of question meaning, or something else. Sexual orientation was dichotomized as either heterosexual or nonheterosexual. Respondents also specified their student status (full-time or part-time) and current relationship status (single, married/domestic partner, separated/widowed/divorced, engaged/committed dating relationship). Respondents who identified as international students or nondegree seeking were excluded from this study.</p> <hd id="AN0150768975-7">Covariates</hd> <p>After a thorough literature review, the following covariates were considered in the analyses: race, sex, age, sexual orientation, and student type. Student type was defined in three categories: students attending a 2-year institution, undergraduates attending a 4-year institution, and graduate/professional students attending a 4-year institution. Data were stratified by race and sex for statistical analyses. Age, sexual orientation, and student type were assessed for confounding (>10% parameter change). These covariates were selected given previous identification of potential differences in abuse prevalence among race, sex, age, sexual orientation, and student type groups.[<reflink idref="bib8" id="ref39">8</reflink>],[<reflink idref="bib40" id="ref40">40</reflink>]<sups>–</sups>[<reflink idref="bib42" id="ref41">42</reflink>] Age and sexual orientation were identified as confounders when assessing each individual ACE.</p> <hd id="AN0150768975-8">Statistical analyses</hd> <p>Data were stratified by self-reported race and sex. Student's <emph>t</emph>-tests and chi-square tests were conducted to assess differences by race in demographic characteristics and average ACEs experienced. Logistic regressions were performed to assess associations between Asians/Pacific Islanders and Whites for each individual ACE and to control for confounders. These analyses were repeated while stratifying for sex. All models were adjusted for age and sexual orientation. Statistical analyses were performed using SAS, version 9.4 (Cary, NC, USA).</p> <hd id="AN0150768975-9">Results</hd> <p></p> <hd id="AN0150768975-10">Demographics</hd> <p>Table 1 contains a summary of the demographics of participants in the 2015 College Student Health Survey (<emph>n</emph> = 8,472), of whom 558 identified as Asian/Pacific Islander (6.59%) and 7,914 identified as White (93.41%). Nearly 70% (<emph>n</emph> = 5,926) of participants identified as female, while 30% identified as male (<emph>n</emph> = 2,546). To determine if student demographic characteristics differed between Asians/Pacific Islanders and Whites, respondents' sex, student status, student type, relationship status, and sexual orientation were assessed. The majority of respondents were full-time college students (<emph>n</emph> = 7,079; 84.27%). More than 60% of respondents were undergraduate students at 4-year institutions (<emph>n</emph> = 5,299) and 15.20% were graduate or professional students (<emph>n</emph> = 1,288). A higher proportion of Whites identified as nonheterosexual relative to Asians/Pacific Islanders (<emph>p</emph> =.02). Overall, 29.86% (<emph>n</emph> = 2,529) had no exposure to ACEs, while more than 10% (<emph>n</emph> = 982) experienced 5 or more ACEs. There was a significant difference in distribution of the number of ACEs among Asians/Pacific Islanders and Whites (Table 1, <emph>p</emph> <.01), while there appeared to be no difference in the mean number of ACEs by race (Table 2, <emph>p</emph> =.39).</p> <p>Table 1. Characteristics of 8,472 Asian/Pacific Islander and non-Hispanic White students responding to the 2015 Minnesota College Student Health Survey.</p> <p> <ephtml> <table><thead><tr><td /><td>Total (<italic>N</italic> = 8472)</td><td>Asian PI (<italic>N</italic> = 558)</td><td>White (<italic>N</italic> = 7914)</td><td><italic>p</italic>-Value (Asian PI vs White)</td></tr><tr><td /><td /><td><italic>Mean (SD)</italic></td><td><italic>Mean (SD)</italic></td><td><italic>Mean (SD)</italic></td><td /></tr></thead><tbody valign="top"><tr><td>Age</td><td>Overall</td><td>24.82 (8.41)</td><td>23.10 (5.62)</td><td>24.94 (8.56)</td><td><bold><.01*</bold></td></tr><tr><td /><td /><td><italic>N (%)</italic></td><td><italic>N (%)</italic></td><td><italic>N (%)</italic></td><td /></tr><tr><td /><td>18–21 years old</td><td>4303 (51.03)</td><td>317 (57.12)</td><td>3986 (50.60)</td><td><bold><.01*</bold></td></tr><tr><td>22–25 years old</td><td>1792 (21.25)</td><td>115 (20.72)</td><td>1677 (21.29)</td></tr><tr><td>25–29 years old</td><td>770 (9.13)</td><td>57 (10.27)</td><td>713 (9.05)</td></tr><tr><td>>29 years old</td><td>1568 (18.59)</td><td>66 (11.89)</td><td>1502 (19.07)</td></tr><tr><td>Sex</td><td>Male</td><td>2546 (30.05)</td><td>170 (30.47)</td><td>2376 (30.02)</td><td char=".">.83</td></tr><tr><td>Female</td><td>5926 (69.95)</td><td>388 (69.53)</td><td>5538 (69.98)</td></tr><tr><td>Student status</td><td>Full-Time</td><td>7079 (84.27)</td><td>476 (86.39)</td><td>6603 (84.13)</td><td char=".">.16</td></tr><tr><td>Part-Time</td><td>1321 (15.73)</td><td>75 (13.61)</td><td>1246 (15.87)</td></tr><tr><td>Student type</td><td>2-year comm/tech/trade/vocational college student</td><td>1885 (22.25)</td><td>125 (22.40)</td><td>1760 (22.24)</td><td char=".">.09</td></tr><tr><td>4-year college/university undergraduate student</td><td>5299 (62.55)</td><td>366 (65.59)</td><td>4933 (62.33)</td></tr><tr><td>4-year college/university graduate/professional student</td><td>1288 (15.20)</td><td>67 (12.01)</td><td>1221 (15.43)</td></tr><tr><td>Relationship status</td><td>Single</td><td>3738 (44.23)</td><td>316 (56.83)</td><td>3422 (43.34)</td><td><bold><.01*</bold></td></tr><tr><td>Married/domestic partner</td><td>1457 (17.24)</td><td>72 (12.95)</td><td>1385 (17.54)</td></tr><tr><td>Separated, widowed, divorced</td><td>151 (1.79)</td><td>5 (0.90)</td><td>146 (1.85)</td></tr><tr><td>Engaged/committed dating relationship</td><td>3105 (36.74)</td><td>163 (29.32)</td><td>2942 (37.26)</td></tr><tr><td>Sexual orientation</td><td>Heterosexual</td><td>7679 (91.12)</td><td>507 (93.89)</td><td>7172 (90.93)</td><td><bold>.02*</bold></td></tr><tr><td>Nonheterosexual</td><td>748 (8.88)</td><td>33 (6.11)</td><td>715 (9.07)</td></tr><tr><td>Number of ACEs</td><td>0</td><td>2529 (29.86)</td><td>178 (31.90)</td><td>2351 (29.71)</td><td><bold><.01*</bold></td></tr><tr><td>1</td><td>2079 (24.55)</td><td>103 (18.46)</td><td>1976 (24.97)</td></tr><tr><td>2</td><td>1332 (15.73)</td><td>105 (18.82)</td><td>1227 (15.51)</td></tr><tr><td>3</td><td>942 (11.12)</td><td>73 (13.08)</td><td>869 (10.98)</td></tr><tr><td>4</td><td>606 (7.15)</td><td>49 (8.78)</td><td>557 (7.04)</td></tr><tr><td>5+</td><td>982 (11.59)</td><td>50 (8.96)</td><td>932 (11.78)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> Bold values with (*) indicators represent statistical significance at <emph>p</emph> <.05.</p> <p>Table 2. Distribution of individual adverse childhood experiences (ACEs) and the adjusted odds ratio of each ACE for Asian/Pacific Islander students relative to non-Hispanic White students in the 2015 Minnesota College Student Health Survey.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>Total</td></tr><tr><td /><td>AsianPI</td><td>White</td><td>Adj. OR [95% CI]</td><td><italic>p</italic>-Value</td></tr><tr><td /><td><italic>Mean (SD)</italic></td><td><italic>Mean (SD)</italic></td><td /><td /></tr></thead><tbody valign="top"><tr><td>Number of ACEs</td><td>1.83 (1.83)</td><td>1.90 (2.04)</td><td /><td>.39</td></tr><tr><td>ACE</td><td /><td><italic>N (%)</italic></td><td><italic>N (%)</italic></td><td /><td /></tr><tr><td /><td>Lived with someone who was mentally ill, depressed, or suicidal</td><td>124 (25.67)</td><td>2624 (36.51)</td><td>0.64 [0.52–0.79]</td><td><bold><.01</bold>*</td></tr><tr><td /><td>Lived with a problem drinker or alcoholic</td><td>77 (14.23)</td><td>1852 (24.14)</td><td>0.58 [0.45–0.74]</td><td><bold><.01*</bold></td></tr><tr><td /><td>Lived with someone who used illegal drugs or abused prescription meds</td><td>43 (8.14)</td><td>1069 (13.95)</td><td>0.58 [0.42–0.80]</td><td><bold><.01*</bold></td></tr><tr><td /><td>Lived with someone who served time or sentenced</td><td>38 (7.02)</td><td>636 (8.15)</td><td>0.84 [0.59–1.19]</td><td>.32</td></tr><tr><td /><td>Parents were separated/divorced</td><td>116 (21.97)</td><td>2077 (27.20)</td><td>0.79 [0.64–0.98]</td><td><bold>.03*</bold></td></tr><tr><td /><td>Parents/adults in home slapped, hit, kicked, punched, or beat each other</td><td>122 (22.18)</td><td>960 (12.18)</td><td>2.27 [1.83–2.83]</td><td><bold><.01*</bold></td></tr><tr><td /><td>Parents/adults in home slapped, hit, kicked, punched, or beat respondent</td><td>123 (22.20)</td><td>1095 (13.89)</td><td>2.04 [1.65–2.53]</td><td><bold><.01*</bold></td></tr><tr><td /><td>Parents/adults in home swore, insulted, or put down respondent</td><td>261 (47.20)</td><td>3403 (43.21)</td><td>1.25 [1.05–1.49]</td><td><bold>.01*</bold></td></tr><tr><td /><td>Someone ≥5 years older than respondent touched respondent sexually</td><td>61 (11.03)</td><td>662 (8.41)</td><td>1.72 [1.29–2.29]</td><td><bold><.01*</bold></td></tr><tr><td /><td>Someone ≥5 years older than respondent tried to make them touch them sexually</td><td>35 (6.38)</td><td>465 (5.91)</td><td>1.40 [0.98–1.07]</td><td>.07</td></tr><tr><td /><td>Someone ≥5 forced respondent to have sex</td><td>20 (3.61)</td><td>218 (2.76)</td><td>1.75 [1.09–2.81]</td><td><bold>.02*</bold></td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note:</emph> Bold values with (*) indicators represent statistical significance at <emph>p</emph> <.05.</p> <hd id="AN0150768975-11">Adverse childhood experiences in Asians and Whites</hd> <p>Asians/Pacific Islanders relative to Whites were significantly less likely to have lived with someone who was mentally ill, who abused alcohol, or who used illegal drugs. Asians/Pacific Islanders were also less likely to have lived with parents who were separated or divorced. However, Asians/Pacific Islanders were more likely to have witnessed parents or adults physically abusing one another (adj. OR = 2.27, <emph>p</emph> <.01), were more likely to have been physically abused themselves (adj. OR = 2.04, <emph>p</emph> <.01), and more likely to have been verbally abused (adj. OR = 1.25, <emph>p</emph> =.01). Asians/Pacific Islanders were also more likely to have been touched sexually (adj. OR = 1.72, <emph>p</emph> <.01) and raped (adj. OR = 1.75, <emph>p</emph> =.02).</p> <p>Table 3 contains comparisons of ACE prevalence in Asians/Pacific Islanders relative to Whites, stratified by sex, and comparisons of ACE prevalence between sexes, stratified by race. Asian/Pacific Islander males were more likely than White males to have witnessed domestic abuse (adj. OR = 2.85, <emph>p</emph> <.01), have been physically abused (adj. OR = 2.59, <emph>p</emph> <.01), and raped (adj. OR = 4.70, <emph>p</emph> <.01). Asian/Pacific Islander females were less likely to have lived with someone who was mentally ill (adj. OR = 0.62, <emph>p</emph> <.01), an alcoholic (adj. OR = 0.53, <emph>p</emph> <.01), someone who used illegal drugs (adj. OR = 0.53, <emph>p</emph> <.01), or lived with separated/divorced parents (adj. OR = 0.74, <emph>p</emph> =.02), relative to White females. However, Asian/Pacific Islander females were significantly more likely than White females to have been physically, emotionally, and sexually abused themselves, in addition to being more likely to having witnessed domestic abuse (Table 3). White females experienced more ACEs relative to White males (Table 3, <emph>p</emph> <.01), and were more likely to experience every ACE except living with a drug abusing household member, living with divorced parents, or witnessing domestic abuse (Table 3).</p> <p>Table 3. Distribution of individual adverse childhood experiences (ACEs) and the adjusted odds ratio of each ACE for Asian/Pacific Islander students stratified by sex relative to non-Hispanic White students in the 2015 Minnesota College Student Health Survey.</p> <p> <ephtml> <table><thead><tr><td /><td>Male</td><td /><td>Female</td><td>AsianPI Male vs AsianPI Female</td><td>White Male vs White Female</td></tr><tr><td /><td /><td>AsianPI</td><td>White</td><td>Adj. OR [95% CI]</td><td><italic>p</italic>-Value</td><td>AsianPI</td><td>White</td><td>Adj. OR [95% CI]</td><td><italic>p</italic>-Value</td><td><italic>p</italic>-Value</td><td><italic>p</italic>-Value</td></tr><tr><td /><td /><td><italic>Mean (SD)</italic></td><td><italic>Mean (SD)</italic></td><td /><td /><td><italic>Mean (SD)</italic></td><td><italic>Mean (SD)</italic></td><td /><td /><td /><td /></tr></thead><tbody valign="top"><tr><td>Number of ACEs</td><td>1.75 (1.85)</td><td>1.63 (1.84)</td><td /><td>0.38</td><td>1.86 (1.82)</td><td>2.02 (2.10)</td><td /><td>.14</td><td>.52</td><td><bold><.01*</bold></td></tr><tr><td>ACE</td><td /><td><italic>N (%)</italic></td><td><italic>N (%)</italic></td><td /><td /><td><italic>N (%)</italic></td><td><italic>N (%)</italic></td><td /><td /><td /><td /></tr><tr><td /><td>Lived with someone who was mentally ill, depressed, or suicidal</td><td>31 (21.23)</td><td>618 (28.72)</td><td>0.70 [0.46–1.06]</td><td>0.10</td><td>93 (27.60)</td><td>2006 (39.84)</td><td>0.62 [0.48–0.79]</td><td><bold><.01*</bold></td><td>.09</td><td><bold><.01*</bold></td></tr><tr><td /><td>Lived with a problem drinker or alcoholic</td><td>23 (13.94)</td><td>463 (20.15)</td><td>0.69 [0.43–1.10]</td><td>0.12</td><td>54 (14.36)</td><td>1389 (25.84)</td><td>0.53 [0.40–0.72]</td><td><bold><.01*</bold></td><td>.77</td><td><bold><.01*</bold></td></tr><tr><td /><td>Lived with someone who used illegal drugs or abused prescription meds</td><td>15 (9.43)</td><td>306 (13.24)</td><td>0.70 [0.40–1.23]</td><td>0.21</td><td>28 (7.59)</td><td>763 (14.26)</td><td>0.53 [0.36–0.79]</td><td><bold><.01*</bold></td><td>.59</td><td>.30</td></tr><tr><td /><td>Lived with someone who served time or sentenced</td><td>17 (10.37)</td><td>163 (6.98)</td><td>1.44 [0.82–2.51]</td><td>0.20</td><td>21 (5.57)</td><td>473 (8.65)</td><td>0.64 [0.41–1.01]</td><td>.06</td><td>.12</td><td><bold>.01*</bold></td></tr><tr><td /><td>Parents were separated/divorced</td><td>37 (23.27)</td><td>593 (25.84)</td><td>0.93 [0.63–1.36]</td><td>0.70</td><td>79 (21.41)</td><td>1484 (27.78)</td><td>0.74 [0.57–0.96]</td><td><bold>.02*</bold></td><td>.65</td><td>.10</td></tr><tr><td /><td>Parents/adults in home slapped, hit, kicked, punched, or beat each other</td><td>38 (22.75)</td><td>247 (10.44)</td><td>2.85 [1.92–4.24]</td><td><bold><0.01*</bold></td><td>84 (21.93)</td><td>713 (12.93)</td><td>2.07 [1.60–2.69]</td><td><bold><.01*</bold></td><td>.76</td><td><bold><.01*</bold></td></tr><tr><td /><td>Parents/adults in home slapped, hit, kicked, punched, or beat respondent</td><td>42 (24.85)</td><td>312 (13.18)</td><td>2.59 [1.77–3.79]</td><td><bold><0.01*</bold></td><td>81 (21.04)</td><td>783 (14.20)</td><td>1.84 [1.42–2.39]</td><td><bold><.01*</bold></td><td>.34</td><td>.35</td></tr><tr><td /><td>Parents/adults in home swore, insulted, or put down respondent</td><td>70 (41.42)</td><td>946 (40.03)</td><td>1.09 [0.79–1.50]</td><td>0.62</td><td>191 (49.74)</td><td>2457 (44.57)</td><td>1.33 [1.08–1.64]</td><td><bold><.01*</bold></td><td><bold>.03*</bold></td><td><bold><.01*</bold></td></tr><tr><td /><td>Someone ≥5 years older than respondent touched respondent sexually</td><td>10 (5.92)</td><td>98 (4.14)</td><td>1.80 [0.87–3.71]</td><td>0.11</td><td>51 (13.28)</td><td>564 (10.24)</td><td>1.72 [1.26–2.36]</td><td><bold><.01*</bold></td><td><bold><.01*</bold></td><td><bold><.01*</bold></td></tr><tr><td /><td>Someone ≥5 years older than respondent tried to make them touch them sexually</td><td>9 (5.36)</td><td>86 (3.63)</td><td>2.02 [0.98–4.18]</td><td>0.06</td><td>26 (6.82)</td><td>379 (6.89)</td><td>1.27 [0.83–1.93]</td><td>.27</td><td>.55</td><td><bold><.01*</bold></td></tr><tr><td /><td>Someone ≥5 forced respondent to have sex</td><td>6 (3.53)</td><td>28 (1.18)</td><td>4.70 [1.81–12.22]</td><td><bold><0.01*</bold></td><td>14 (3.65)</td><td>190 (3.44)</td><td>1.38 [0.79–2.41]</td><td>.27</td><td>.97</td><td><bold><.01*</bold></td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note:</emph> Bold values with (*) indicators represent statistical significance at <emph>p</emph> <.05.</p> <hd id="AN0150768975-12">Comment</hd> <p>In this study, we found significant differences in individual ACE exposure between Asian/Pacific Islander and White Minnesota college students, with many of these associations being sex-specific. We found no statistically significant differences in total ACE exposure between Asians/Pacific Islanders and Whites, despite literature that suggests Asian/Pacific Islander children are less likely to be exposed to ACEs.[<reflink idref="bib8" id="ref42">8</reflink>],[<reflink idref="bib27" id="ref43">27</reflink>],[<reflink idref="bib31" id="ref44">31</reflink>] When considering individual ACEs, our study supported previous child maltreatment studies that identified higher prevalence of physical and emotional abuse among Asians/Pacific Islanders than among Whites.[<reflink idref="bib32" id="ref45">32</reflink>],[<reflink idref="bib34" id="ref46">34</reflink>]</p> <p>However, we also report results that noticeably contrast previous research. We observed greater prevalence of sexual abuse among Asians/Pacific Islanders relative to Whites and that the manner in which they were sexually abused differed by sex. In their review of child maltreatment among Asian Americans, Zhai et al. hypothesized that sociocultural factors thought to be associated with Asian communities (such as an emphasis on stoicism and familial harmony) may actually reduce sexual abuse or prevent disclosure.[<reflink idref="bib36" id="ref47">36</reflink>] Our findings suggest that the prevalence of sexual abuse is not as low among Asians/Pacific Islanders as previously reported, and that cultural norms may not accurately explain low reported rates of sexual abuse in Asian/Pacific Islander communities. Given that high rates of sexual abuse are rarely documented among Asians/Pacific Islanders, we suggest that college students may be more willing to disclose history of sexual abuse than previously studied populations.</p> <p>Assessment and intervention efforts aimed at mitigating the negative impact of ACEs may need to adjust their programs to target specific populations. Given that we observed significant differences in individual ACE prevalence between Asians/Pacific Islanders and Whites – differences that were often sex-specific – communities that have a higher proportion of a given racial/ethnic group or gender may require additional resources to meet the needs for that particular community. Although some prevention and intervention efforts currently aimed at serving individuals who have experienced ACEs have been culturally tailored for minority populations, substantial variation exists in the distribution of individual ACEs between racial/ethnic groups.[<reflink idref="bib43" id="ref48">43</reflink>],[<reflink idref="bib44" id="ref49">44</reflink>] Therefore, further modifications may be required for communities that report higher rates of particular types of trauma.</p> <p>Differences in individual ACE exposure between racial/ethnic groups may produce varying health effects. In our study, household dysfunction ACEs (incarcerated family member, divorced parents, etc.) were generally more prevalent in Whites (specifically White females), while child maltreatment ACEs (physical, emotional, and sexual abuse) were generally more prevalent among Asians/Pacific Islanders. While it is still unknown whether household dysfunction ACEs and child maltreatment ACEs cause similar health outcomes, some evidence suggests that not all ACEs are associated with the same negative health effects.[<reflink idref="bib45" id="ref50">45</reflink>],[<reflink idref="bib46" id="ref51">46</reflink>] If household dysfunction ACEs increase the risk of different health outcomes than child maltreatment ACEs, health burdens may vary between Asians/Pacific Islanders, Whites, and other racial/ethnic groups.</p> <hd id="AN0150768975-13">Limitations</hd> <p>Limitations for this study include the following. First, racial groups were categorized as a binary of either Asian/Pacific Islander or White. Differences may exist in ACE prevalence between more specific racial groups within Asians, Pacific Islanders, and Whites that cannot be discerned given the survey's racial categories. Additionally, international students and respondents who identified as being of mixed race were excluded from the analysis. These groups may also exhibit variation in individual ACE prevalence. We were also unable to investigate negative health outcomes associated with ACE exposure due to small sample size among Asians/Pacific Islanders. Consequently, we could not adjust for covariates without risking sparse data bias. Furthermore, ACE exposure was treated as a dichotomous outcome. Relevant differences may exist in the number of times a respondent was exposed to a given ACE during his or her childhood.</p> <p>Because our study was based on data gathered from students in institutions of higher education, respondents were more likely to be from a higher socioeconomic status than certain communities in the general population. Given the association between ACEs and socioeconomic status, such heterogeneity could affect the prevalence of ACEs among our study population, as well as the resources available for students to address issues arising from harmful childhood experiences.[<reflink idref="bib8" id="ref52">8</reflink>],[<reflink idref="bib27" id="ref53">27</reflink>] Data about household income were not available for these analyses, thus excluding the possibility of controlling for socioeconomic factors. Additionally, the data were self-reported, making the responses susceptible to recall error and bias.</p> <hd id="AN0150768975-14">Conclusions</hd> <p>The prevalence of ACEs among Minnesota's college-aged students differs between Asians/Pacific Islanders and Whites and by sex. Intervening during college-aged years provides an excellent opportunity for preventing potential long-term effects of ACEs, yet such interventions must recognize that significant variability can exist in individual ACE exposure between Asians/Pacific Islanders and other racial groups. Further studies are needed to better characterize ACEs among specific Asian communities, including immigrants, international students, and those of mixed race. In subsequent research, investigators could also ascertain the frequency with which children experience ACEs, as well as the age during which they experience these events, in order to establish a more robust understanding of ACE prevalence and effect among specific racial/ethnic populations.</p> <hd id="AN0150768975-15">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of the University of Minnesota.</p> <ref id="AN0150768975-16"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Afifi TO, Enns MW, Cox BJ, et al. Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. 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Psychol Violence. 2014; 4 (4): 432.</bibtext> </blist> </ref> <aug> <p>By Andrew Sieben; Katherine Lust; Ainslee Crose; Lynette M. Renner and Ruby H. N. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Race and Sex Differences in Adverse Childhood Experiences among Asian/Pacific Islander College Students
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Sieben%2C+Andrew%22">Sieben, Andrew</searchLink><br /><searchLink fieldCode="AR" term="%22Lust%2C+Katherine%22">Lust, Katherine</searchLink><br /><searchLink fieldCode="AR" term="%22Crose%2C+Ainslee%22">Crose, Ainslee</searchLink><br /><searchLink fieldCode="AR" term="%22Renner%2C+Lynette+M%2E%22">Renner, Lynette M.</searchLink><br /><searchLink fieldCode="AR" term="%22Nguyen%2C+Ruby+H%2E+N%2E%22">Nguyen, Ruby H. N.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2021 69(4):353-360.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 8
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2021
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Asian+American+Students%22">Asian American Students</searchLink><br /><searchLink fieldCode="DE" term="%22Pacific+Islanders%22">Pacific Islanders</searchLink><br /><searchLink fieldCode="DE" term="%22White+Students%22">White Students</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Differences%22">Racial Differences</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Incidence%22">Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Experience%22">Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Abuse%22">Child Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Rape%22">Rape</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Abuse%22">Sexual Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Trauma%22">Trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Violence%22">Violence</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Minnesota%22">Minnesota</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2019.1677671
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2021
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1297048
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1297048
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2019.1677671
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 353
    Subjects:
      – SubjectFull: Asian American Students
        Type: general
      – SubjectFull: Pacific Islanders
        Type: general
      – SubjectFull: White Students
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Incidence
        Type: general
      – SubjectFull: Experience
        Type: general
      – SubjectFull: Child Abuse
        Type: general
      – SubjectFull: Rape
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Sexual Abuse
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Trauma
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Violence
        Type: general
      – SubjectFull: Minnesota
        Type: general
    Titles:
      – TitleFull: Race and Sex Differences in Adverse Childhood Experiences among Asian/Pacific Islander College Students
        Type: main
  BibRelationships:
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            NameFull: Sieben, Andrew
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            NameFull: Lust, Katherine
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            NameFull: Crose, Ainslee
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            NameFull: Renner, Lynette M.
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            NameFull: Nguyen, Ruby H. N.
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          Dates:
            – D: 01
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              Type: published
              Y: 2021
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
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            – Type: volume
              Value: 69
            – Type: issue
              Value: 4
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            – TitleFull: Journal of American College Health
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