Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

Abstract

This study compared the prevalence of adverse childhood experiences (ACEs) across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate ACE prevalence estimates. Unadjusted one-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative ACE measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted to estimate ACE scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Compared to straight participants, adolescents with same-sex attractions and adults who identified with a sexual minority group reported more ACEs overall, though associations varied by ACE type. Strikingly, ACE scores were higher among White than Black youth with same-sex attractions, more economically advantaged than poor bisexual adults, and poor White than poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A MAIHDA interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative ACE scores whereas gender and race/ethnicity did not. The results show that ACE disparities can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that ACEs are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.