617 - Intersectional Representation in Adverse Childhood Experiences Research: Patterns in Measurement and Outcomes

Publication Number: 3598.617

Eileen Wang, McMaster University Michael G. DeGroote School of Medicine, Thornhill, ON, Canada; Amber D.. Rieder, Mcmaster University, Burlington, ON, Canada; Raiyan Rubab, McMaster University, Hamilton, ON, Canada; Vanessa De Rubeis, McMaster University, Hamitlon, ON, Canada; Krysta Andrews, McMaster University, Hamilton, ON, Canada; Katrina Abela, McMaster University Michael G. DeGroote School of Medicine, Bolton, ON, Canada; Natalie Harvey-Younis, McMaster University Michael G. DeGroote School of Medicine, Brampton, ON, Canada; Andrea Gonzalez, McMaster University, Hamilton, ON, Canada

Background: Adverse Childhood Experiences (ACEs) are associated with long-term health outcomes. However, the original 10-item ACE framework narrowly reflected household adversities. The globalization of ACEs discourse invites an examination of how individual experiences intersect with structural challenges

Objective: This analysis aims to identify equity gaps in ACEs research by (1) examining how studies of intersectional populations measure ACEs across individual, community, and social levels and (2) characterize how these populations are represented across outcomes.

Design/Methods: This is a secondary analysis of a parent systematic review of 410 studies applying an intersectional lens (per Crenshaw/Bowleg) to evaluate differences in ACEs representation. The review searched Medline, Embase, Global Index Medicus, PsycINFO, and Global Health for studies measuring ACEs beyond the 10 original items, following PRISMA. Eligible studies were child or adult samples reporting adversities at family, community, or societal levels. Studies were classified as intersectional if they examined ACEs within a defined intersectional group (e.g., race/ethnicity, gender identity, health status). ACEs were cross tabulated with outcome and intersectional variables to examine patterns.

Results: Across 410 studies, 5606 ACEs were coded across family (n=3726), community (n=1146), and societal (n=734) levels. Among these, 184 studies examined intersectional populations, most often by race/ethnicity (21.2%) and health status (12.5%), while immigration status was the least represented (0.5%); 3.2% combined multiple axes. ACE categories were broadly similar between intersectional and non-intersectional studies. Family violence (36.6%) predominated at the family level and community violence (45.6%) at the community level. At the societal level, structural identity-based oppression (28.5%) and gender-based violence (21.4%) were most common. Measurement emphasized family and community ACEs, with limited focus on structural ACEs. Mental health was the most studied outcome within intersectional groups (40.5%), whereas healthcare use was the least (4.6%).

Conclusion(s): Measurement has expanded to include family, community, and social adversities; however, intersectional approaches remain sparse. Where present, ACE categories assessed resemble those in non-intersectional studies. A narrow focus on specific outcomes also limits understandings of how adversity interacts with identity across health and social domains. Contextually sensitive measures are needed to strengthen ACEs research and guide interventions addressing the life-course impacts globally.