Multiple Adverse Childhood Experiences (ACEs) and Socio-Ecological Factors Associated with Children’s Utilization of Safety Net Programs in the United States

Adverse childhood experiences (ACEs) are traumatic events associated with food insecurity, poor health, and socioeconomic challenges. This study estimates the prevalence and associations of ACEs, socio-ecological factors, and children’s utilization of safety net programs in the United States (U.S.). In this study, ACEs are defined as experiencing economic hardships, parental separation or divorce, parental death, parental incarceration; witnessing domestic violence in the home or neighborhood; being victims of violence; living with someone with mental illness, or substance abuse issues; and being mistreated due to race/ethnicity, health conditions/disability, and sexual orientation. The data used for this study was derived from the 2022 National Children’s Health Survey (NCHS). An analytic sample of 54,103 children (51.6% male; average age = 8.6 years) was used. Chi-square tests (cross-tabulations) were used to obtain the prevalence estimates across bivariate. Four logistic regression models were employed to predict significant associations between multiple ACEs, socio-ecological factors, and children’s utilization of safety net programs. The statistical significance was determined at the p-value of 0.05 using SPSS vs.29.0. According to parental reports, 37.2% of children utilized some form of safety net programs. After controlling for other factors in the regression models, experiencing at least one ACE (29%; aOR = 1.43; 95% CI = 1.33–1.53), two ACEs (57%; aOR = 1.87; 95% CI = 1.67–2.09), and three or more ACEs (69.7%; aOR = 2.60; 95% CI = 2.31–2.93) were significantly associated with increased odds of children’s utilization of safety net programs. Similarly, living in households with poverty, food insecurity, unemployed parents, single-parent households, and Spanish-speaking households, and living in metropolitan or run down neighborhoods were significantly associated with higher odds of children’s utilization of safety net programs. However, living in households where parents had at least an associate degree or higher was significantly associated with decreased odds of children’s utilization of safety net programs. This study highlights the importance of implementing comprehensive social welfare programs and policies to mitigate the negative impact of ACEs, reduce poverty, and address food insecurity, which drives children and their families to rely increasingly on safety net programs. Implications for policy and practice are discussed further.