American Indians and Alaska Natives must be included in research on adverse childhood experiences

Publication Date:

Nov 08, 2018

Adverse Childhood Experiences (ACEs) are an increasing area of interest among researchers, practitioners, and policymakers. As this field of study grows, an equity lens can facilitate a greater understanding of the structural, historic, and systemic contexts that relate to limited ACEs data for American Indians and Alaska Natives (AI/ANs), as well as disparate exposures to ACEs among this population. Three factors are important to consider in support of more equitable outcomes: AI/AN population characteristics, historical trauma and resilience, and tribal sovereignty.

First, characteristics of the AI/AN population require concerted efforts by researchers to include this population in the rapidly developing ACEs field. The population’s size and diversity, age distribution, and percentage of children living in poverty underscore this consideration. In the United States, an estimated 5.6 million people (1.7 percent of the total population) self-identify as AI/AN alone or in combination with one or more other races,[1] and there are currently 573 federally recognized tribes.

 

The AI/AN population is relatively young, which means it is particularly important to understand how adverse childhood experiences (ACEs) affect this population.

Share of children under age 18 in 2016*, among the AI/AN national and AI/AN state populations.

States U.S.

*Note: Data are from the 2016 American Community Survey 1-year estimates, with the exception of statistics for North Dakota and Wyoming, which come from 2013 ACS 3-year estimates. States with no data presented have small AI/AN populations; therefore, the ACS data were suppressed.

Source: U.S. Census Bureau (2016). Table S0201: Selected Population Profile in the United States, 2016 American Community Survey 1-year estimates. Retrieved from http://factfinder2.census.gov.

Because the AI/AN population represents one of the smaller racial/ethnic groups in the United States, studies often do not include samples adequate for disaggregated AI/AN findings. Consequently, AI/AN data are typically grouped in an “Other” category, or not analyzed at all. Additionally, when AI/AN statistics are reported, they are often thought to represent a monolithic group, an assumption that overlooks the unique cultures, histories, and contexts of the many tribes in the United States. Meaningful inclusion of AI/ANs in future ACEs work will require oversampling, research and analyses focused on states or regions with large AI/AN populations, and direct partnership with tribes. Prior ACEs work in states like South Dakota and Minnesota and with multiple tribes can serve as examples.

Approximately 29.3 percent of AI/ANs are under age 18 (versus 22.8 percent of the total U.S. population).
Source: U.S. Census Bureau (2016). Table S0201: Selected Population Profile in the United States, 2016 American Community Survey 1-year estimates. Retrieved from http://factfinder2.census.gov.

The AI/AN population is also relatively young. In fact, in eight states children under age 18 are estimated to make up one-third or more of the AI/AN population. From a public health perspective, this means that a focus on ACEs among AI/ANs could deliver important long-term benefits—especially given that ACEs increase the level of risk for many of the same negative outcomes (e.g., alcohol and substance use, mental health disorders) that Indian Health Service (IHS) data indicate are concerns for AI/ANs nationally and in specific IHS regions.

 

AI/AN children are more likely than children in the total population to live in poverty nationally and in 22 states.

Share of children in poverty in 2016*, among the total population and the AI/AN population

AI/AN population Total population

*Note: Data are from the 2016 American Community Survey 1-year estimates, with the exception of statistics for North Dakota and Wyoming, which come from 2013 ACS 3-year estimates. States with no data presented have small AI/AN populations; therefore, the ACS data were suppressed.

Source: U.S. Census Bureau (2016). Table S0201: Selected Population Profile in the United States, 2016 American Community Survey 1-year estimates. Retrieved from http://factfinder2.census.gov.

In addition, data indicate that economic hardship represents a challenge to the well-being of AI/AN children. Child Trends’ recent ACEs research brief, which presents data from the 2016 National Survey of Children’s Health, found that economic hardship was one of the most common ACEs reported nationally and in all states. While the brief grouped AI/AN data in an “Other, Non-Hispanic” category due to small sample size, its findings are informative when considered alongside AI/AN data from other sources. For example, among the 25 states with concurrent American Community Survey AI/AN estimates, 18 states had an estimated 25 percent or more AI/AN children under age 18 living in poverty—and three had estimates of over 40 percent (see second figure).

Roughly 27.8 percent of AI/AN children under age 18 live in poverty (versus 19.5 percent of children under age 18 in the total U.S. population).
Source: U.S. Census Bureau (2016). Table S0201: Selected Population Profile in the United States, 2016 American Community Survey 1-year estimates. Retrieved from http://factfinder2.census.gov.

Additionally, according to the brief, the percentage of children with two or more ACEs is significantly higher among “Other, Non-Hispanic” children, which includes AI/ANs, than among “White, Non-Hispanic” children in three regions that encompass several states with large AI/AN populations (Mountain, West North Central, and East North Central). This finding is also in line with an analysis of 2011-2012 National Survey of Children’s Health data, which showed that, nationally, AI/AN children were two to three times more likely to have experienced multiple ACEs compared to non-Hispanic white children. Researchers cannot draw formal conclusions from comparisons across these sources; however, they suggest the need for further inclusion of AI/ANs in ACEs efforts.

AI/AN children are more likely to have experienced certain adverse childhood experiences, which can have negative effects throughout their lives.

ACEs have been linked with numerous negative outcomes, including alcoholism, drug abuse, depression, suicide, and poor physical health.

AI/AN children are more likely than children in the total U.S. population to have:

  • Lived in poverty (27.8 versus 19.5 percent)
  • Observed domestic violence (15.5 versus 6.3 percent)
  • Been a victim of violence or witnessed violence in their neighborhood (15.9 versus 11.6 percent)
  • Lived with a substance abuser (23.6 versus 11.6 percent)
  • Divorced parents (33 versus 21.4 percent)
  • Lived with a parent who died (4.2 versus 2.5 percent)

Second, researchers should consider concepts of historical trauma and resilience in their efforts to understand ACEs among AI/AN populations. Child Trends’ brief notes that there is “no single agreed-upon list of experiences that encompass what we refer to as adverse childhood experiences.” To address links between ACEs and AI/AN well-being, it is essential that we understand whether some adversities are uniquely important to AI/AN contexts. For instance, AI/AN scholars have written for decades about the concept of multi-level, intergenerational impacts of historical trauma. Some have even begun to incorporate measures that capture symptoms of historical trauma alongside standard ACEs measures to better understand health outcomes for AI/AN youth.

Perhaps more importantly, tribal contexts also include unique strengths. Many tribes have invested in programs and services that enhance and revitalize the languages, traditions, and values that have sustained AI/AN peoples and communities for centuries. Understanding how these cultural elements have fostered—and continue to foster—resilience in the face of adversity will be critical for developing relevant and effective ACEs prevention and intervention for AI/AN populations.

Finally, tribal sovereignty must be acknowledged to address resource needs and develop sustainable ACEs prevention and intervention strategies. Tribal programs and services tasked with delivery of support in tribal contexts are often severely underfunded. To overcome this challenge, partners interested in addressing ACEs among AI/ANs must acknowledge that, in addition to comprising a racial/ethnic category, tribes have access to powerful policy and program levers to address population health and well-being. This means that federal policies with tribal implications require government-to-government consultation. Furthermore, national and state-level collaboration with tribes on policy and program initiatives, funding mechanisms, and services to address ACEs can ensure that tribes take part in and benefit from future solutions.

The study of ACEs is rapidly evolving. Applying an equity lens to this field will ensure that AI/ANs are included in attempts to understand and address ACEs and their impacts, thereby promoting more equitable outcomes for all children. This will require deliberate efforts to include AI/ANs in new studies and to address measurement and resource needs that exist in AI/AN contexts. However, even the sparse existing data indicate that ACEs are common among AI/ANs, and that increased attention to adverse experiences among AI/AN children stands to tremendously benefit their long-term well-being.

[1] Census data in this blog are from Table S0201: Selected Population Profile in the United States, 2016 American Community Survey 1-year estimates. State-level 2016 ACS 1-year estimates were not available for North Dakota and Wyoming, which were within the top 10 states with the highest percentage of AI/ANs according to the 2010 U.S. Census; therefore, for comparisons across states, estimates for ND and WY were taken from TableS0201: Selected Population Profile in the United States, 2013 American Community Survey 3-year estimates.