The Social Determinants of Adverse Childhood Experiences: An Intersectional Analysis of Place, Access to Resources, and Compounding Effects

Int J Environ Res Public Health. 2022 Aug 27;19(17):10670. doi: 10.3390/ijerph191710670.


Children across all races/ethnicities and income levels experience adverse childhood experiences (ACEs); however, historically excluded children and families must contend with added adversities across ecological levels and within higher-risk conditions due to systemic inequality. In this grounded theory study, the authors examined how health and social service providers (N = 81) from rural and urban counties in Tennessee provided services to low-income families, children exposed to opioids, and children of immigrants. Guided by an intersectional framework, the authors examined how rural and urban settings shaped higher risk conditions for ACEs and impeded access to resources at the individual, group, and community levels. Findings from this study identified additionally marginalized subpopulations and demonstrated how inequitable environments intersect and compound the effects of ACEs. The authors present their Intersectional Nature of ACEs Framework to showcase the relationship between high-risk conditions and sociopolitical and economic circumstances that can worsen the effects of ACEs. Ultimately, the Intersectional Nature of Aces Framework differentiates between ACEs that are consequences of social inequities and ACEs that are inflicted directly by a person. This framework better equips ACEs scholars, policymakers, and stakeholders to address the root causes of inequality and mitigate the effects of ACEs among historically excluded populations.

Keywords: adverse childhood experiences; child abuse; child neglect; household dysfunction; intersectionality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Childhood Experiences*
  • Humans
  • Poverty
  • Racial Groups
  • Rural Population
  • Social Determinants of Health*

Grants and funding

Support for this research was provided by the Robert Wood Johnson Foundation’s Policies for Action program (Grant #75821). The views expressed here do not necessarily reflect the views of the Foundation.