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Abstract
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Adverse Childhood Experiences, or ACEs, are potentially traumatic yet preventable events that occur in childhood (0-17 years) and include exposure to neglect, abuse, and experiencing or witnessing violence (Centers for Disease Control and Prevention, 2019; Felitti et al., 2019). Also included are experiences that undermine the child's sense of safety, stability, and caregiver bonding, such as growing up with a household member who engages in substance use or has mental health problems or being separated from a parent due to death, illness, incarceration, or other circumstances (Felitti et al., 2019). These examples do not comprise an exhaustive list of childhood adversity; other traumatic experiences could impact health and wellbeing, including those that occur outside of the caregiver and household context, such as exposure to community violence (Finkelhor et al., 2015; Karatekin & Hill, 2019). ACEs often occur together, can result in toxic stress, and are associated with a wide range of adverse behavioral, health, and social outcomes, such as substance use, depression, obesity, heart disease, cancer, and lower education and earning potential (Merrick et al., 2019).
While ACEs are well-studied overall, most data have been collected in adult surveys and in high-income countries (HIC) (Gordon & Afifi, 2020; Hughes et al., 2017; Madigan et al., 2023) while youth in low-to-middle-income-countries (LMIC) remain under-studied. This is problematic because adults may have some difficulty recalling childhood experiences (whether due to memory or coping mechanisms) and it is likely that there are childhood adversities unique to or more prevalent in LMIC compared to HIC (Ceccarelli et al., 2022; Freyd & Deprince, 2001; Mersky et al., 2017). For example, children in LMIC may more commonly be exposed to adversities such as lacking basic needs, poverty, orphanhood, poor nutrition, food insecurity, inability to secure safe housing, an unstable home environment, unhygienic living conditions, exposure to pathogens and environmental toxins, institutionalization, multiple barriers to school attendance, harmful gender norms, child labor, child marriage, community and collective violence, forced conscription into armies, political instability, forced migration, refugee status, and complex humanitarian emergencies (Bhutta et al., 2023; Cluver et al., 2013; Finkelhor et al., 2015; Karatekin & Hill, 2019). Furthermore, the majority of the world's children reside in LMIC, making the HIC-centered generalization of ACEs research of particular concern. Some studies have suggested that youth in LMIC have a higher prevalence of ACEs than youth in HIC because of the unique and complex environments in which they grow and develop (Blum et al., 2019; Ceccarelli et al., 2022). While environmental factors in LMICs may present more risk for adversity compared to HICs, there may also be unique environmental factors that are protective against adversity in comparison to HIC. For example, strong social support systems, collectivism, intergenerational living, and religion may promote resilience and less internet penetration and the digital gap may shield youth from some forms of violence and exploitation (International Telecommunication Union, 2024; Mhaka-Mutepfa & Maundeni, 2019; Treleaven, 2023; Wu et al., 2023; Yuan et al., 2022). After 30 years since the landmark CDC-ACE Study, the field needs to understand the burden of ACEs among children and young adults across a broader range of settings, cultures, and contexts. Thus, to have a complete picture of ACEs epidemiology, impact, and possible prevention strategies, there is the need to have a more comprehensive understanding of the adversities faced by children and young adults living in LMIC.
Language: en |