B3623 - The impact of Adverse Childhood Experiences on social and health inequalities a life course perspective - 06/10/2020

B number: 
Principal applicant name: 
Laura Howe | MRC Integrative Epidemiology Unit at the University of Bristol (United Kingdom)
Gwen Fernandes, Jon Heron, Liz Washbrook, John Macleod, Hugh McLeod
Title of project: 
The impact of Adverse Childhood Experiences on social and health inequalities: a life course perspective
Proposal summary: 

Adverse Childhood Experiences (ACEs) are stressful events that occur during childhood and adolescence, and include child maltreatment (i.e. emotional, physical, and sexual abuse and neglect) as well as measures of family dysfunction (e.g. parental divorce/separation, intimate partner violence, substance misuse, mental illness, and imprisonment). People who experience ACEs are less likely to do well in school, more likely to become unemployed, and more likely to have poor health. Furthermore, since people who live in socioeconomic deprivation are more at risk of experiencing ACEs, and also more at risk of poor health, ACEs are one mechanism that could drive socioeconomic inequalities in health. However, most of the research to date has looked at ACEs as a whole, and not asked whether experiencing ACEs at different points during infancy, childhood and adolescence might have different impacts. This is important, because it affects decisions about how we best support people who experience ACEs. If ACEs in infancy have the biggest effect on later outcomes, then focusing support on the early years will be most beneficial. Whereas if ACEs at older ages also cause problems, potentially ‘derailing’ people from their previous educational level for example, that would imply that continued support across the whole of childhood and adolescence is important. At a time when local government budgets are severely stretched, generating evidence to help support the justification and prioritisation of interventions is crucial. At present, our ability to carry out high-quality cost-effectiveness analysis of interventions to mitigate the effects of ACEs is limited by a lack of good evidence on the effects of ACEs on key economic outcomes, and how these effects differ across the life course. In this project, we will plug this gap, using extremely detailed data about experiences of ACEs across the life course, linked with detailed family and socioeconomic data, and repeated measures of educational attainment, employment, and health. We will explore the links between ACEs and education and employment, whether these are affected by the timing, duration and recency of ACE exposure, and the mechanisms underlying the associations.
The 2020 SARS-Cov-2 pandemic is likely to have severe implications for children experiencing ACEs and adults who have experienced ACEs. The ‘lockdown’ measures are likely to lead to increased occurrence of ACEs. Missed schooling is likely to be more detrimental for already vulnerable children, and many children who were entitled to continue attending school during lockdown did not do so. Job losses and reductions in income have been concentrated in the already disadvantaged, and the uncertain job market going forwards will pose a greater risk to young adults without the cushioning of a stable family environment and educational success. Using new data collected during the pandemic, we will assess whether young adults who have experienced ACEs are more vulnerable to the economic consequences of the pandemic, e.g. reduced income, furlough, or job loss. This evidence could provide support to the continued and increased need for the provision of services for people experiencing ACEs at this time.
We will work with key academic and non-academic collaborators to ensure that the results from this project are used to support the case for services designed to support people who have experienced ACEs, including with our results being used directly to improve the quality of cost-effectiveness analyses for interventions.

Impact of research: 
A key route for non-academic dissemination will be via the local government teams in the West of England (Bristol, North Somerset, Bath and North East Somerset, South Gloucestershire, Gloucestershire, Wiltshire and Swindon) with whom the team already have strong links. The local teams have expressed an interest in modelling the cost-effectiveness of interventions to mitigate the adverse effects of ACEs, in order to support the ‘business case’ for their planned initiatives, at a time when local government budgets are under severe pressure. The results from this project will be used to directly feed in to the modelling of specific interventions of interest to local teams by the team at the NIHR Applied Research Collaboration (ARC) West.
Date proposal received: 
Thursday, 24 September, 2020
Date proposal approved: 
Tuesday, 29 September, 2020
Social Science, Childhood - childcare, childhood adversity, Social science