Research Article|Articles in Press

Intersectionality and Adverse Childhood Experiences: Comparing Subgroups of Sex, Race/Ethnicity, and Sexual Orientation


      This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation.


      Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnicity (White/Hispanic/Black/multiracial/other), and sexual orientation (heterosexual/bisexual/gay) to investigate the number of ACEs across groups. Analyses were conducted in 2022.


      Stratification resulted in 30 distinct subgroups (e.g., bisexual Black females, straight multiracial males) with significant post hoc differences per group. Generally, those identifying as sexual minority individuals had the highest number of ACEs (the top 14 of 30 subgroups), whereas 7 of the top 10 subgroups were female. Surprisingly, no clear patterns emerged by race/ethnicity, although the 2 largest groups (straight White females and straight White males) were 27th and 28th of 30, respectively.


      Although studies have examined ACEs by individual demographic variables, less is known about the extent to which ACEs are present in stratified subgroups. Sexual minority subgroups (particularly female bisexual subgroups) trend toward a higher number of ACEs, whereas heterosexual subgroups (regardless of sex) comprised the lowest 6 groups with respect to ACEs. Implications include further examination of bisexual and female subgroups (including specific ACE domain investigations) to identify the vulnerable population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Felitti VJ
        • Anda RF
        • Nordenberg D
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.
        Am J Prev Med. 1998; 14: 245-258
        • Hughes K
        • Bellis MA
        • Hardcastle KA
        • et al.
        The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.
        Lancet Public Health. 2017; 2: e356-e366
        • Giano Z
        • Camplain RL
        • Camplain C
        • et al.
        Adverse childhood events in American Indian/Alaska native populations.
        Am J Prev Med. 2021; 60: 213-221
        • Giano Z
        • Wheeler DL
        Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S.
        BMC Public Health. 2020; 20: 1327
        • LaBrenz CA
        • O'Gara JL
        • Panisch LS
        • Baiden P
        • Larkin H
        Adverse childhood experiences and mental and physical health disparities: the moderating effect of race and implications for social work.
        Soc Work Health Care. 2020; 59: 588-614
        • Lee RD
        • Chen J.
        Adverse childhood experiences, mental health, and excessive alcohol use: examination of race/ethnicity and sex differences.
        Child Abuse Negl. 2017; 69: 40-48
        • Zettler HR
        • Craig JM.
        Residentially-placed youth and the adverse childhood experiences-recidivism relationship: considering racial/ethnic and sex differences.
        Am J Crim Just. 2022; : 1-15
        • Andersen JP
        • Blosnich J.
        Disparities in adverse childhood experiences among sexual minority and heterosexual adults: results from a multi-state probability-based sample.
        PLoS One. 2013; 8: e54691
        • Craig SL
        • Austin A
        • Levenson J
        • Leung VWY
        • Eaton AD
        • D'Souza SA
        Frequencies and patterns of adverse childhood events in LGBTQ+ youth.
        Child Abuse Negl. 2020; 107104623
        • Pasha-Zaidi N
        • Afari E
        • Urganci B
        • Sevi B
        • Durham J.
        Investigating the relationship between Adverse Childhood Experiences (ACEs) and resilience: a study of undergraduate students in Turkey.
        J Aggress Maltreat Trauma. 2020; 29: 1204-1221
        • Liu SR
        • Kia-Keating M
        • Nylund-Gibson K
        • Barnett ML.
        Co-occurring youth profiles of adverse childhood experiences and protective factors: associations with health, resilience, and racial disparities.
        Am J Community Psychol. 2020; 65: 173-186
        • Petruccelli K
        • Davis J
        • Berman T.
        Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis.
        Child Abuse Negl. 2019; 97104127
        • Blosnich JR
        • Andersen JP.
        Thursday's child: the role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual U.S. adults.
        Soc Psychiatry Psychiatr Epidemiol. 2015; 50: 335-338
        • Zou C
        • Andersen JP.
        Comparing the rates of early childhood victimization across sexual orientations: heterosexual, lesbian, gay, bisexual, and mostly heterosexual.
        PLoS One. 2015; 10e0139198
        • Austin A
        • Herrick H
        • Proescholdbell S.
        Adverse childhood experiences related to poor adult health among lesbian, gay, and bisexual individuals.
        Am J Public Health. 2016; 106: 314-320
        • Clements-Nolle K
        • Lensch T
        • Baxa A
        • Gay C
        • Larson S
        • Yang W.
        Sexual identity, adverse childhood experiences, and suicidal behaviors.
        J Adolesc Health. 2018; 62: 198-204
        • Ports KA
        • Lee RD
        • Raiford J
        • Spikes P
        • Manago C
        • Wheeler DP.
        Adverse childhood experiences and health and wellness outcomes among black men who have sex with men.
        J Urban Health. 2017; 94: 375-383
      1. V Sacks and D. Murphey, The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity, 2018, Child Trends; Bethesda, MD. Published February 12. Accessed May 10, 2022.

        • Strompolis M
        • Tucker W
        • Crouch E
        • Radcliff E.
        The intersectionality of adverse childhood experiences, race/ethnicity, and income: implications for policy.
        J Prev Interv Community. 2019; 47: 310-324
        • Maguire-Jack K
        • Lanier P
        • Lombardi B.
        Investigating racial differences in clusters of adverse childhood experiences.
        Am J Orthopsychiatry. 2020; 90: 106-114
      2. Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. In: Maschke K, Maschke K, eds. Feminist Legal Theories. 1st ed. New York, NY: Routledge; 2013:23–51.

        • Crenshaw K.
        Mapping the margins: intersectionality, identity politics, and violence against women of color.
        Stanford Law Rev. 1991; 43: 1241-1299
      3. Collins PH. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York, NY: Routledge; 2002.

        • Carbado DW
        • Crenshaw KW
        • Mays VM
        • Tomlinson B.
        INTERSECTIONALITY: mapping the movements of a theory.
        Du Bois Rev. 2013; 10: 303-312
        • Cho S
        • Crenshaw KW
        • McCall L.
        Toward a field of intersectionality studies: theory, applications, and praxis.
        Signs. 2013; 38: 785-810
        • Bauer GR
        • Churchill SM
        • Mahendran M
        • Walwyn C
        • Lizotte D
        • Villa-Rueda AA.
        Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods.
        SSM Popul Health. 2021; 14100798
        • Bowleg L.
        The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.
        Am J Public Health. 2012; 102: 1267-1273
        • Mullings L
        • Schulz AJ.
        Intersectionality and health: an introduction.
        in: Schulz AJ Mullings L Gender, Race, Class, & Health: Intersectional Approaches. Jossey-Bass/Wiley, San Francisco, CA2006: 3-17
        • Mersky JP
        • Choi C
        • Plummer Lee C
        • Janczewski CE
        Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: intersectional analysis of a nationally representative sample.
        Child Abuse Negl. 2021; 117105066
        • Merrick MT
        • Ford DC
        • Ports KA
        • Guinn AS.
        Prevalence of adverse childhood experiences from the 2011–2014 behavioral risk factor surveillance system in 23 states.
        JAMA Pediatr. 2018; 172 ([published correction appears in JAMA Pediatr. 2018;172(11):1104]): 1038-1044
        • Ford DC
        • Merrick MT
        • Parks SE
        • et al.
        Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores.
        Psychol Violence. 2014; 4: 432-444
        • Johnston R
        • Jones K
        • Manley D.
        Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour.
        Qual Quant. 2018; 52: 1957-1976
        • Fuller-Thomson E
        • Baird SL
        • Dhrodia R
        • Brennenstuhl S.
        The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study.
        Child Care Health Dev. 2016; 42: 725-734
        • Corliss HL
        • Cochran SD
        • Mays VM.
        Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults.
        Child Abuse Negl. 2002; 26: 1165-1178
        • Romano E
        • De Luca RV.
        Male sexual abuse: a review of effects, abuse characteristics, and links with later psychological functioning.
        Aggress Violent Behav. 2001; 6: 55-78
        • Noor SW
        • Sutherland JE
        • Vernon JRG
        • Adam BD
        • Brennan DJ
        • Hart TA.
        Measuring adverse childhood experiences: comparing individual, composite, score-based and latent profile-based scoring schemas among gay, bisexual, and other men who have sex with men.
        Arch Sex Behav. 2020; 49: 1741-1754
        • Pérez-Fuentes G
        • Olfson M
        • Villegas L
        • Morcillo C
        • Wang S
        • Blanco C.
        Prevalence and correlates of child sexual abuse: a national study.
        Compr Psychiatry. 2013; 54: 16-27
        • Diamanduros T
        • Cosentino CE
        • Tysinger PD
        • Tysinger JA.
        Theoretical perspectives of male sexual abuse: conceptualization of a case study.
        J Child Sex Abus. 2012; 21: 131-154
        • Giano Z
        • Ernst CW
        • Snider K
        • Davis A
        • O'Neil AM
        • Hubach RD
        ACE domains and depression: investigating which specific domains are associated with depression in adulthood.
        Child Abuse Negl. 2021; 122105335
      4. Kniffley S. Institutionalized mental trauma and generational transmission. In Williams JM, Kniffley S, eds. Black Males and the Criminal Justice System. 1st ed. New York, NY: Routledge; 2019:109–120.

        • Phipps RM
        • Degges-White S.
        A new look at transgenerational trauma transmission: second-generation Latino immigrant youth.
        J Multicult Couns Devel. 2014; 42: 174-187
        • Giano Z
        • Hubach RD.
        Adverse childhood experiences and mental health: comparing the link in rural and urban men who have sex with men.
        J Affect Disord. 2019; 259: 362-369
        • Garduno LS.
        How influential are Adverse Childhood Experiences (ACEs) on youths?: analyzing the immediate and lagged effect of ACEs on deviant behaviors.
        J Child Adolesc Trauma. 2021; 15: 683-700
        • Plumb JL
        • Bush KA
        • Kersevich SE.
        Trauma-sensitive schools: an evidence-based approach.
        Sch Soc Work J. 2016; 40: 37-60
        • Narayan AJ
        • Lieberman AF
        • Masten AS.
        Intergenerational transmission and prevention of adverse childhood experiences (ACEs).
        Clin Psychol Rev. 2021; 85101997
        • Chandler GE
        • Roberts SJ
        • Chiodo L.
        Resilience intervention for young adults with adverse childhood experiences.
        J Am Psychiatr Nurses Assoc. 2015; 21: 406-416
      5. Edward R The problem with ‘ACEs’: Edwards et al.’s submission to the House of Commons Science and Technology Select Committee Inquiry into the evidence-base for early years intervention (EY10039). Published December 2017. Accessed May 10, 2022.

        • Lanier P
        • Maguire-Jack K
        • Lombardi B
        • Frey J
        • Rose RA.
        Adverse childhood experiences and child health outcomes: comparing cumulative risk and latent class approaches.
        Matern Child Health J. 2018; 22: 288-297
        • Bond MA
        • Stone AL
        • Salcido Jr, R
        • Schnarrs PW.
        How often were you traumatized? Reconceptualizing adverse childhood experiences for sexual and gender minorities.
        J Affect Disord. 2021; 282: 407-414
        • Evans CR
        • Erickson N.
        Intersectionality and depression in adolescence and early adulthood: a MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008.
        Soc Sci Med. 2019; 220: 1-11