Examining the Role of Social Support and Neighborhood Deprivation in the Relationship Between Multiple ACEs and Health Risk Behaviors

Abstract

The accumulation of multiple adverse childhood experiences (ACEs) is associated with the disproportionate development of health risk behaviors (HRBs), such as smoking, substance use, physical inactivity, and risky HIV behaviors. The impact of neighborhood social inequities on the association between multiple ACEs and HRBs is not well known. This study aims to examine the impact of stressors associated with neighborhood deprivation on ACE-related HRBs, the potential protective factor of perceived social support (PSS), as well as better understand disproportionality experienced by racial/ethnic minorities. Through merging data from the 2010 Washington State Behavioral Risk Factor Surveillance System survey (n = 5,447) with the Neighborhood Deprivation Index (NDI), an NDI value is assigned based on participant zip code. Using structural equation modeling, this study demonstrates neighborhood deprivation mediates the relationship between multiple ACEs and HRBs, while both low and high PSS moderate this relationship. Additionally, the impact of exposure to multiple ACEs on health risk behaviors remained steady regardless of race/ethnicity. Acknowledging the contributions of neighborhood stressors and individual protective resources furthers the ACEs knowledgebase by providing a more integrated model of ACE-related disease production, improving explanatory mechanisms and clarifying the role of socio-structural factors in health disparities. Further, contextualizing the unique variances in ACE-related pathways depending on social and neighborhood factors enables more holistic interventions and preventative action at the community level, including policies targeting poverty, education, and housing conditions and increasing community social support assets.