The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

• Type of Material: Article
• Authors: Krista Schroeder, Temple University; Levent Dumenci, Temple University; David B Sarwer, Temple University; Jennie G Noll, Pennsylvania State University; Kevin A Henry, Temple University; Shakira Suglia, Emory University; Christine M Forke, University of Pennsylvania Perelman School of Medicine; David C Wheeler, University School of Medicine
• Language: English
• Date: 2022-07-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph19137819
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• Volume: 19
• Issue: 13
• Grant/Funding Information: The Philadelphia ACE Survey was funded by the Robert Wood Johnson Foundation and was supported by the Thomas Scattergood Behavioral Health Foundation and the Stoneleigh Foundation. The content is solely the responsibility of the authors and does not necessarily represent the views of the funders. The funders had no role in study design; collection, analysis, and interpretation of data; writing the report; nor the decision to submit the report for publication.; This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 HD101554 PI: Schroeder) and (P50 HD089922; PI: Noll) of the National Institutes of Health. David B. Sarwer’s work was supported by grant funding from the National Institutes of Health (National Institute for Diabetes, Digestive, and Kidney Disease R01 DK108628 and National Institute of Dental and Craniofacial Research R01 DE026603).
• Keywords: Residence Characteristics; adverse childhood experiences; obesity; methods; Health Promotion; spatial; index; trauma; Cross-Sectional Studies; geospatial; Adverse Childhood Experiences; Bayes Theorem; neighborhood; neighborhood ACEs index; Humans
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Nursing; Biology, Biostatistics

Abstract

This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.