• Neal Halfon, Kandyce Larson, John Son, Michael Lu, and Christina Bethell.
• University of California Los Angeles Center for Healthier Children, Families and Communities, Los Angeles, Calif; Department of Pediatrics, University of California Los Angeles Geffen School of Medicine, Los Angeles, Calif; Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health; and Department of Public Policy, University of California Los Angeles Luskin School of Public Affairs, Los Angeles, Calif. Electronic address: nhalfon@ucla.edu.
• Acad Pediatr. 2017 Sep 1; 17 (7S): S70-S78.

ObjectiveAdverse childhood experiences (ACEs) can affect health and development across the life course. Despite a general understanding that adversity is associated with lower income, we know less about how ACEs manifest at different income levels and how these income-related patterns affect children's health and development.MethodsData from the 2011 to 2012 National Survey of Children's Health were used to examine the prevalence of 9 ACEs in US children, across 4 levels of household income, and in relationship to 5 parent-reported measures of child health. Bivariate analyses and multivariable logistic regression models were used to examine the associations between number of ACEs and children's health outcomes on the basis of the 4 income groups.ResultsWhen partitioned according to income strata, the proportion of children who experienced ACEs showed a steep income gradient, particularly for children who experienced ≥4 ACEs. The linear gradient across income groups was less pronounced for each specific ACE, with several ACEs (experience of divorce, drug and alcohol exposure, parental mental illness) showing high reported prevalence in all but the highest income group. Multivariate analysis showed a consistent income-related gradient for each of the health outcomes. However, higher income was not necessarily found to be a protective factor against ACEs.ConclusionsACEs are distributed across the income ladder and not just concentrated below the poverty level. This suggests that a more comprehensive policy strategy that includes targeted as well as universal interventions is warranted.Copyright © 2016 Academic Pediatric Association. All rights reserved.

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