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Am J Prev Med. 2016 Jan;50(1):47-56. doi: 10.1016/j.amepre.2015.06.013. Epub 2015 Sep 2.

Racial Disparities in Child Adversity in the U.S.: Interactions With Family Immigration History and Income.

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Department of Epidemiology and Biostatistics, University of Maryland College Park, School of Public Health, College Park, Maryland. Electronic address:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Center on the Developing Child, Harvard University, Cambridge, Massachusetts; Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts; Harvard Graduate School of Education, Cambridge, Massachusetts.
University of California, San Francisco, School of Medicine, San Francisco, California.
Department of Applied Psychology, New York University, New York, New York.
Georgetown University Medical Center, Washington, District of Columbia.
Center on the Developing Child, Harvard University, Cambridge, Massachusetts.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.



Childhood adversity is an under-addressed dimension of primary prevention of disease in children and adults. Evidence shows racial/ethnic and socioeconomic patterning of childhood adversity in the U.S., yet data on the interaction of race/ethnicity and SES for exposure risk is limited, particularly with consideration of immigration history. This study examined racial/ethnic differences in nine adversities among children (from birth to age 17 years) in the National Survey of Child Health (2011-2012) and determined how differences vary by immigration history and income (N=84,837).


We estimated cumulative adversity and individual adversity prevalences among white, black, and Hispanic children of U.S.-born and immigrant parents. We examined whether family income mediated the relationship between race/ethnicity and exposure to adversities, and tested interactions (analyses conducted in 2014-2015).


Across all groups, black and Hispanic children were exposed to more adversities compared with white children, and income disparities in exposure were larger than racial/ethnic disparities. For children of U.S.-born parents, these patterns of racial/ethnic and income differences were present for most individual adversities. Among children of immigrant parents, there were few racial/ethnic differences for individual adversities and income gradients were inconsistent. Among children of U.S.-born parents, the Hispanic-white disparity in exposure to adversities persisted after adjustment for income, and racial/ethnic disparities in adversity were largest among children from high-income families.


Simultaneous consideration of multiple social statuses offers promising frameworks for fresh thinking about the distribution of disease and the design of targeted interventions to reduce preventable health disparities.

[Indexed for MEDLINE]

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