589568 research-article2015

JIVXXX10.1177/0886260515589568Journal of Interpersonal ViolenceVaughn et al.

Article

Adverse Childhood Experiences Among Immigrants to the United States

Journal of Interpersonal Violence 1­–22 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260515589568 jiv.sagepub.com

Michael G. Vaughn, PhD,1 Christopher P. Salas-Wright, PhD,2 Jin Huang, PhD,1 Zhengmin Qian, MD, PhD,1 Lauren D. Terzis, MSW,1 and Jesse J. Helton, PhD1

Abstract A growing number of studies have examined the “immigrant paradox” with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of firstand second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified—limited adverse experience (n = 3,497), emotional and

1Saint 2The

Louis University, MO, USA University of Texas at Austin, USA

Corresponding Author: Michael G. Vaughn, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, St. Louis, MO 63103, USA. Email: [email protected]

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physical abuse (n = 1,262), family violence (n = 358), and global adversity (n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards. Keywords child maltreatment, physical and sexual abuse, family violence, immigrants, immigrant paradox, mental health, substance use, violence and crime

Introduction Adverse childhood experiences (ACE) such as physical and sexual abuse, neglect, and witnessing family violence are associated with a wide swath of deleterious outcomes in adulthood (Anda et al., 2006; Briere & Jordan, 2009; Dube, Felitti, Dong, Giles, & Anda, 2003; Kalmakis & Chandler, 2013). Behavioral problems (Gorey & Leslie, 1997; Moylan et al., 2010), low selfesteem and depression (Anda et al., 1999; Chapman et al., 2004; Dube et al., 2001; Gorey & Leslie, 1997; Moylan et al., 2010), substance use (Anda et al., 1999; Dube et al., 2001; Gorey & Leslie, 1997), and criminal behaviors (Gorey & Leslie, 1997; Moylan et al., 2010) are just some of the outcomes that have been found to be associated with ACE. Emerging evidence suggests that substantial heterogeneity exists among individuals with respect to the various types of ACE experiences (Dunn et al., 2011; Vaughn, Salas-Wright, Underwood, & Gochez-Kerr, 2014); however, studies have also found that children who are exposed to one type of childhood abuse or household dysfunction are also likely to be exposed to at least another one (Felitti et al., 1998). Despite accumulated research derived from U.S. samples, relatively little is known about ACE among immigrant children. Immigrant parents are often placed in stressful situations created by low socioeconomic status (SES; lowincome employment and less education), and cultural and language barriers once moved to the United States. Immigrant parents are at an increased risk of experiencing stress associated with low SES, and in turn are at an increased

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risk of maltreating their child (Alink, Euser, van IJzendoorn, & BakermansKranenburg, 2013). Culture may play a role for first-generation immigrants, as parenting styles from their country of origin may clash with values in the United States (Strasburger, 2013). Many immigrant parents, including Latino parents, are more likely to engage in “authoritarian style” child rearing practices (Fontes, 2002), which is characterized by high controlling behaviors and low in behaviors that are responsive to a child’s needs (Sleddens, Gerards, Thijs, Vries, & Kremers, 2011). Similarly, Asian immigrants to the United States often encounter criticism due to their harsh discipline style that is not congruent with the dominant U.S. culture (Larsen, Kim-Goh, & Nguyen, 2008). Limited research on immigrants and child maltreatment suggests that child rearing practices that lead to adverse outcomes may exist among parents who have been in the United States for a shorter period of time, are of younger age, and are less educated (Rhee, Chang, Berthold, & Mar, 2012). Studies have suggested that differing cultural values within immigrant populations can attribute to domestic violence. Factors such as polygamy, traditional roles of the husband and wife, infidelity, extended family and their power over the married couple, and the “universal institution of bride price” can contribute to domestic violence in immigrant families (Magwa, 2013). Immigrant women and their children may not realize the abuse they are enduring is not common in the United States, because it may be considered normal in their home country. Incidents of ACE may go unreported in immigrant communities in the United States, as women and their children may not realize that the abusive behavior they are enduring is considered illegal in the United States. In addition, immigrants often choose not to disclose information to the police due to fear of deportation and losing their children (Clark, 2007). Furthermore, research suggests that U.S. police officers often view violence and neglect in the family as behaviors that are inherently part of the cultures of many immigrants (Menjívar & Salcido, 2002). This could deter immigrant women and children from seeking and reporting abuse to officials, which could explain the lack of knowledge on ACE among immigrant children.

Current Study Aim Prior research has established a paradox where immigrants are healthier than native-born Americans despite greater disadvantage. A recent spate of studies has extended the immigrant paradox to crime and antisocial behavior (Butcher & Piehl, 2006; Hagan & Palloni, 1999; Lee, Martinez, & Rosenfeld, 2001; Martinez & Lee, 2000; Stowell, Messner, McGeever, & Raffalovich, 2009; Vaughn, Salas-Wright, DeLisi, & Maynard, 2014; Vaughn, Salas-Wright,

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Maynard et al., 2014), substance use (Prado et al., 2009; Salas-Wright, Vaughn, Clark, Terzis, & Córdova, 2014), and mental health (Escobar, 1998; Escobar, Nervi, & Gara, 2000; Salas-Wright, Kagotho, & Vaughn, 2014). However, little research has accrued that has compared immigrants with native-born Americans with respect to sexual and physical abuse, neglect, and exposure to family violence (e.g., witnessing father or adult male threatening or hitting your mother). The present investigation fills this gap by examining these forms of ACE among first- and second-generation immigrants and native-born Americans using an 18-item retrospective measure. Furthermore, we identify and describe latent subgroups of immigrants based on sexual and physical abuse, neglect, and witnessing family violence and Diagnostic and Statistical Manual of Mental Disorders (DSM) substance use and mental health disorders. In so doing, we take advantage of a large population-based sample to fully capture and specify the empirical status of ACE among immigrants to the United States.

Method Sample and Procedures Study findings are based on data from Wave I (2001-2002) and Wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a nationally representative sample of non-institutionalized U.S. residents aged 18 years and older. The survey gathered background data and extensive information about substance use and comorbid psychiatric disorders and information about childhood events, family, and general background characteristics from individuals living in households and group settings such as shelters, college dormitories, and group homes in all 50 states and the District of Columbia. NESARC utilized a multistage cluster sampling design, oversampling young adults, Hispanics, and African Americans in the interest of obtaining reliable statistical estimation in these subpopulations, and to ensure appropriate representation of racial/ ethnic subgroups. Multistage cluster sampling design is a commonly used design when attempting to provide nationally representative estimates. This is because interviewing all participants is not feasible, so larger units (i.e., clusters) are identified and randomly selected from. With respect to the NESARC, 709 primary sampling units (PSUs) provided by the Census Supplementary Survey was selected (Stage 1). Within the sample PSUs, households were systematically selected (Stage 2). An individual aged 18 or older was randomly selected from each household. The response rate for Wave I data was 81% and for Wave II 86.7% (N = 34,653) with a cumulative

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response rate of 70.0% for both waves. Data were weighted at the individual and household levels to adjust for oversampling and non-response on demographic variables (i.e., age, race/ethnicity, sex, region, and place of residence). Data were also adjusted to be representative (based on region, age, race, and ethnicity) of the U.S. adult population as assessed during the 2000 Census. Adjustments were also made by NESARC investigators to account for any sociodemographic or psychiatric differences resulting from Wave 2 non-response. This process is described in greater detail elsewhere (see Grant et al., 2008; Grant, Kaplan, & Stinson, 2007). Study participants provided fully informed consent. The U.S. Census Bureau and the U.S. Office of Management and Budget approved the research protocol and informed consent procedures. Sociodemographic information on U.S.-born as well as firstand second-generation immigrants in the Waves I and II NESARC samples is available elsewhere (Salas-Wright et al., 2014). Data were collected through face-to-face structured psychiatric interviews conducted by U.S. Census workers trained by the National Institute on Alcohol Abuse and Alcoholism and U.S. Census Bureau. Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule–Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) version (AUDADIS-IV), which has been shown to have good-to-excellent reliability in the diagnosis of mental disorders in the general population (Grant, Hartford, Dawson, Chou, & Pickering, 1995; Hasin, Carpenter, McCloud, & Grant, 1997). Participants had the option of completing the NESARC interview in English, Spanish, or one of four Asian languages (i.e., Mandarin, Cantonese, Korean, and Vietnamese). More details about the NESARC design and procedures are available elsewhere (Grant & Dawson, 2006).

Measures Childhood adverse experience.  At Wave II interviews, study participants were asked about 18 measures of childhood adverse experiences in the domains of neglect, emotional and physical abuse, family violence, and sexual abuse. These items were drawn from previously validated measures including the Childhood Trauma Questionnaire (Bernstein et al., 1994) and Conflict Tactics Scale (Straus, 1979). Consistent with previous research, items were dichotomously coded (0 = no, 1 = yes) depending on whether the respondent reported having ever experienced a specific adversity as a child (McLaughlin, Conron, Koenen, & Gilman, 2010; Vaughn et al., 2011). Table 1 provides a comprehensive list of each of these items.

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Neglect   Any neglect   Parent/caregiver . . .    Made to do chores that were too difficult or dangerous for someone your age    Left you alone or unsupervised when you were too young to be alone    Went without things you needed like clothes, shoes, or school supplies because a parent or other adult living in your home spent the money on themselves    Made you go hungry or did not prepare regular meals    Ignored or failed to get you medical treatment when you were sick or hurt Abuse   Any physical/emotional abuse   Parent/other adult living in your home . . .    Swore at you, insulted you, or said hurtful things    Threatened to hit you or throw something at you, but didn’t do it    Made you afraid that you would be physically hurt/injured    Pushed, shoved, slapped, or hit you    Hit you so hard that you had marks or bruises or were injured

  [0.90, 0.99] [0.94, 1.04] [0.87, 0.95] [0.84, 0.94] [0.94, 1.10] [0.87, 1.00]

[1.45, 1.56] [1.55, 1.66] [1.32, 1.42] [1.32, 1.43] [1.36, 1.47] [1.34, 1.48]

0.99 0.91 0.89 1.02 0.93

1.50 1.61 1.37 1.37 1.41 1.41

(95% CI)

0.95

ARR

Native-Born Americans (n = 24,461)

1.40 1.38 1.40 1.37 1.33

(continued)

[1.35, 1.46] [1.33, 1.44] [1.35, 1.46] [1.32, 1.42] [1.27, 1.40]

[1.35, 1.47]

[0.84, 0.99] [0.74, 0.87]

0.91 0.80

1.41

[0.85, 0.92] [0.77, 0.86]

[0.77, 0.85]

0.81 0.89 0.82

[0.83, 0.90]

(95% CI)

0.87

ARR

Second-Generation Immigrants (n = 4,826)

Table 1.  Adjusted Risk Ratios for Adverse Childhood Experiences Among Non-Immigrants and Second-Generation Immigrant Adults With First-Generation Immigrants as the Reference Group.

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[1.37, 1.52] [1.40, 1.56] [1.43, 1.63] [1.33, 1.57] [1.41, 1.63]

[1.34, 1.48] [1.43, 1.60] [1.18, 1.34] [1.29, 1.45] [1.20, 1.38]

1.47 1.53 1.44 1.51

1.41 1.51 1.26 1.37 1.29

(95% CI)

1.44

ARR

Native-Born Americans (n = 24,461)

1.13

1.22

1.35

1.38

1.31

1.51 1.53 1.35 1.32

1.48

ARR

[1.04, 1.23]

[1.13, 1.32]

[1.26, 1.45]

[1.28, 1.49]

[1.23, 1.40]

[1.44, 1.58] [1.44, 1.62] [1.26, 1.45] [1.21, 1.45]

[1.42, 1.54]

(95% CI)

Second-Generation Immigrants (n = 4,826)

Note. Reference group: First-generation immigrants (n = 5,363). Adjusted odds ratios adjusted for age, gender, race/ethnicity, household income, education level, marital status, region of the United States, and urbanicity. Odds ratios in bold are significant at p < .05 or lower. ARR = adjusted risk ratios; CI = confidence intervals.

Domestic violence   Any domestic violence   Father/other adult male . . .    Pushed, grabbed, slapped, or threw something at your mother    Kicked, bit, hit your mother with a fist or with something hard    Repeatedly hit your mother for at least a few minutes    Threatened your mother with a knife or gun or used a knife or gun to hurt her Sexual abuse   Any sexual abuse   Adult/other person . . .    Fondled you in a sexual way when you didn’t want them to or when you were too young to know what was happening    Had you touch their body in a sexual way that you didn’t want to or were too young to know what was happening    Attempted to have sexual intercourse with you when you didn’t want them to or were too young to know what was happening    Actually had sexual intercourse with you when you didn’t want them to or were too young to know what was happening



Table 1.  (continued)

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Immigrant status.  At Wave I, respondents were asked whether they and their parents were born in the United States. Three mutually exclusive categories were created: Respondents who reported having been born outside the United States (n = 5,363) were classified as first-generation immigrants. Respondents who reported that they had been born in the United States but at least one parent had been born outside the United States (n = 4,826) were classified as second-generation immigrants. Respondents who reported that they and their parents were born in the United States were considered native-born Americans (n = 24,461). Mental disorders.  Using the AUDADIS-IV administered during Waves I and II, we examined lifetime DSM-IV mood (i.e., bipolar disorder, major depression, dysthymia), anxiety (i.e., generalized anxiety disorder, panic disorder, social phobia, specific phobia, and posttraumatic stress disorder), and personality disorders (i.e., antisocial, avoidant, borderline, narcissistic, obsessive– compulsive, paranoid, schizoid, and schizotypal). We also examined alcohol, cannabis, and other illicit drug (i.e., heroin, hallucinogens, cocaine/crack, marijuana, stimulants, painkillers, tranquilizers, or sedatives) use disorders (abuse/dependence) by means of the AUDADIS-IV. Sociodemographic controls.  The following sociodemographic variables assessed at Wave I were included as controls (in the multinomial regression) and indicator covariates (in the latent class analysis [LCA]): age, gender, race/ethnicity, household income, education level, marital status, region of the United States, and urbanicity.

Data Analysis Analyses were executed in several successive steps. We first examined the prevalence of childhood adverse experiences among native-born Americans and across immigrant generations (n = 34,650). Next, we examined the relationship between childhood adverse experience and mental and behavioral health among immigrants (n = 5,363). These steps are described in greater detail below. We examined the prevalence of each of the 18 childhood adverse experiences among first-generation immigrants, second-generation immigrants, and native-born Americans. Next, we executed a series of multinomial regression analyses to contrast the prevalence of childhood adverse experiences among first-generation immigrants with those of second-generation immigrants and native-born Americans. We present adjusted risk ratios (ARR), which are conceptually similar to odds ratios in that they refer to the

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likelihood of membership in a specified class versus that of a reference class (Zhang & Yu, 1998). Given the large sample of immigrants and likely heterogeneity, we conducted an LCA to identify subgroups of immigrants on the basis of the 18 child adverse experience indicator variables and sociodemographic indicator covariates. Specifically, a sequence of latent class models was identified between one and five classes using Latent GOLD® 4.5 (Vermunt & Magidson, 2008) software. Five statistical criteria were used to identify the best fitting model: the Bayesian Information Criterion (BIC), Akaike’s Information Criterion (AIC), Consistent Akaike’s Information Criterion (CAIC), Log Likelihood, and entropy. In interpreting these criteria, lower BIC, AIC, and CAIC values and higher log likelihood and entropy values reflect better model fit. Substantive criteria (i.e., parsimony, interpretability) were also considered. After identifying the best model and assigning cases to nominal groups, we examined the association between class membership and the prevalence of mental disorders and antisocial behavior using multinomial regression. For all statistical analyses, weighted prevalence estimates and standard errors were computed using Stata 13.1 SE software (StataCorp, 2013).

Results Adverse Childhood Experience Among Immigrants and NonImmigrants Figure 1 presents the prevalence of self-reported experiences of adverse childhood events among native-born Americans and first- and secondgeneration immigrants. Table 1 displays the ARRs for ACEs among nativeborn Americans and second-generation immigrant adults with first-generation immigrants as the reference group. Controlling for sociodemographic factors, native-born Americans (ARR = 0.95, 95% confidence interval [CI] = [0.90, 0.99]) and second-generation immigrants (ARR = 0.87, 95% CI = [0.83, 0.90]) were significantly less likely to report having experienced any form of neglect as compared with first-generation immigrants. Notably, with respect to second-generation immigrants, this relationship held for all manifestations of neglect examined; however, among native-born Americans, effects were only observed for “left unsupervised” (ARR = 0.91, 95% CI = [0.87, 0.95]) and “go without things” (ARR = 0.89, 95% CI = [0.84, 0.94]). Controlling for the same array of sociodemographic factors, compared with first-generation immigrants, native-born Americans and second-generation immigrants were significantly more likely to report exposure to emotional and physical abuse (native-born American: ARR = 1.50, 95% CI =

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34

29

24

19

14

9

4

Non-Immigrant

Second-Generaon Immigrant

First-Generaon Immigrant

Figure 1.  Prevalence of self-reported experience of adverse childhood events.

[1.45, 1.56]; second-generation immigrants: ARR = 1.41, 95% CI = [1.35, 1.47]), family violence (native-born American: ARR = 1.44, 95% CI = [1.37, 1.52]; second-generation immigrants: ARR = 1.48, 95% CI = [1.42, 1.54]), and sexual abuse (native-born American: ARR = 1.41, 95% CI = [1.34, 1.48]; second-generation immigrants: ARR = 1.31, 95% CI = [1.23, 1.40]). As evidenced by the overlapping 95% CIs, the magnitude of the relationship between immigrant status and these ACEs is not significantly different between native-born Americans and second-generation immigrants as compared with first-generation immigrants. In addition, it should be noted that, with varying effect sizes, this relationship held for all manifestations of ACEs examined in these domains.

Latent Subgroups of Immigrants Based on Adverse Childhood Experiences An evaluation of the fit indices and substantive criteria suggests that a fourclass solution was the optimal modeling of the data. There was an accelerated flattening of the differences in the log likelihood, BIC, AIC, and CAIC values suggesting that the addition of a fifth class would not be parsimonious. Moreover, inspection of entropy values suggests that the four-class solution

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100 90 80 70 60 50 40 30 20 10 0

Class 1: "Limited Adverse Experience" (n = 3497; 65.21%)

Class 2: "Child Emoonal and Physical Abuse" (n = 1262; 23.53%)

Class 3: "Child and Family Violence" (n = 358; 6.68%)

Class 4: Global Adversity" (n = 246; 4.59%)

Figure 2.  Adverse childhood events across latent classes.

has acceptable model fit. These statistical criteria also cohere with the substantive interpretability of the four-class solution, which offers a conceptually clear modeling of the heterogeneity of the data. As illustrated in Figure 2, the four classes can be readily distinguished from one another on the basis of ACEs in the domains of neglect, emotional and physical abuse, family violence, and sexual abuse. The four-class solution is composed of the following classes: Class 1: “Limited Adverse Experience” (n = 3,497; 65.21%), Class 2: “Child Emotional and Physical Abuse” (n = 1,262; 23.53%), Class 3: “Child and Family Violence” (n = 358; 6.68%), and Class 4: “Global Adversity” (n = 246; 4.59%). Class 1, which includes nearly two out of every three respondents in the immigrant subsample, is characterized by universally low levels of ACEs across all domains. Class 2, accounting for nearly one in four respondents in the immigrant subsample, is characterized by moderate levels of neglect and elevated levels of emotional and physical abuse in combination with relatively low levels of family violence and sexual abuse. Class 3, which is notably smaller than the first two classes, is characterized by similar levels of neglect, emotional and physical abuse, and sexual abuse as those identified in Class 2; however, this class is also characterized by exceedingly

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elevated levels of family violence. Finally, Class 4, the smallest of all four classes, is characterized by elevated levels of all ACEs examined in the study.

Sociodemographic Characteristics of the Latent Classes Table 2 presents the sociodemographic characteristics of the four latent classes and for the entire sample of immigrants. Significant bivariate differences were observed for age (F = 19.06, p < .001), gender (χ2 = 72.75, p < .001), race/ethnicity (χ2 = 32.14, p < .001), household income (χ2 = 22.20, p < .001), and education (χ2 = 49.35, p < .001). Class 1 (Limited Adverse Experience) is relatively evenly distributed in terms of gender (female = 52.99%, male = 47.01%) and is composed of the highest proportion of nonHispanic White respondents (23.62%). Class 2 (Child Emotional and Physical Abuse) has the highest proportion of male respondents (59.54%) as well as the highest proportion of respondents earning more than $70,000 per year (26.68%) and possessing a post-secondary degree (36.63%). Class 3 (Child and Family Violence) is the youngest of all classes (M = 43.58, SD = 13.54) and is composed of the highest proportion of Hispanic respondents (54.33%). Class 4 (Global Adversity) is the oldest of all classes (M = 48.11, SD = 15.23) and is composed of the highest proportion of female respondents (61.43%) as well as respondents of “other” ethnicity (26.98%), residing in households earning less than $20,000 per year (28.71%), and reporting less than a high school diploma (44.25%).

Supplementary Analyses We also examined various immigration-related factors in relation to membership in the four latent classes. Controlling for the same list of sociodemographic confounds, significant differences were observed with respect to the developmental age at the time of immigrant arrival. Compared with the reference class (Class 1: Limited Adverse Experience), members of Class 2 (Child Emotional and Physical Abuse; ARR = 1.43, 95% CI = [1.35, 1.51]) and Class 3 (Child and Family Violence; ARR = 2.49, 95% CI = [2.32, 2.68]) were significantly more likely to have immigrated during childhood (i.e., age 12 or younger). Although effects were relatively small, members of Class 2 (Child Emotional and Physical Abuse) were also significantly more likely to have arrived during their teenage years (ARR = 1.10, 95% CI = [1.02, 1.18]). No significant differences in the developmental age at the time of immigrant arrival were observed for Class 4 (Global Adversity). In addition, no significant differences were observed with respect to total duration—commonly used as a proxy for acculturation—as an immigrant in the United States.

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M (SD)/n (%)



Sociodemographic factors   Age   Gender   Female   Male  Race/ethnicity   Non-Hispanic White   African American   Asian/Other   Hispanic   Global region   Africa   Latin America   Europe   Asia

(n = 1,262; 23.53%)

(n = 3,497; 65.21%)



44.26 (14.39) 626 (40.46) 636 (59.54) 226 (20.94) 155 (9.82) 169 (22.51) 712 (46.73) 26 (1.70) 685 (51.94) 205 (20.74) 165 (25.62)

47.62 (16.59)

2,073 (52.99) 1,424 (47.01)

613 (23.62) 292 (6.90) 476 (24.30) 2,125 (45.18)

69 (2.20) 2,094 (49.98) 518 (20.85) 459 (26.96)

M (SD)/n (%)

Class 2: Child Emotional and Physical Abuse

Class 1: Limited Adverse Experience

Table 2.  Sociodemographic Characteristics by Latent Class.

6 (1.33) 238 (61.23) 40 (14.74) 41 (22.71)

45 (17.32) 34 (8.37) 41 (19.98) 238 (54.33)

214 (54.68) 144 (45.32)

43.58 (13.54)

M (SD)/n (%)

(n = 358; 6.68%)

Class 3: Child and Family Violence

4 (2.32) 152 (52.47) 29 (15.20) 39 (30.00)

31 (15.94) 22 (9.35) 40 (26.98) 153 (47.73)

163 (61.43) 83 (38.57)

48.11 (15.23)

M (SD)/n (%)

(n = 246; 4.59%)

Class 4: Global Adversity

105 (2.04) 3,169 (51.19) 792 (20.24) 704 (26.53)

915 (22.31) 503 (7.78) 717 (23.74) 3,228 (46.18)

3,076 (50.48 2,287 (49.52)

46.58 (15.93)

M (SD)/n (%)

Full Immigrant Sample

(continued)

18.71***

32.14***

72.75***

19.06***

F/χ2 Significance

14

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M (SD)/n (%)

  291 (21.15) 267 (20.43) 400 (31.75) 304 (26.68) 335 (25.37) 253 (19.64) 227 (18.36) 447 (36.63)

975 (22.76) 819 (22.67) 1,059 (32.07) 644 (22.51)

1,135 (29.33) 783 (21.89) 508 (14.66) 1,071 (34.13)

124 (33.29) 74 (19.94) 52 (14.81) 108 (31.96)

95 (23.18) 101 (23.94) 104 (35.02) 58 (17.86)

M (SD)/n (%)

(n = 358; 6.68%)

Class 3: Child and Family Violence

Note. All percentages are reported as column percentages; HS = high school. *p < .05. **p < .01. ***p < .001.

  Household income (in US$)   70,000  Education    Less than HS   HS graduate   Some post-secondary   Post-secondary degree

(n = 1,262; 23.53%)

(n = 3,497; 65.21%)

  M (SD)/n (%)

Class 2: Child Emotional and Physical Abuse

Class 1: Limited Adverse Experience

Table 2.  (continued)

103 (44.25) 38 (14.78) 43 (16.38) 62 (24.59)

70 (28.71) 61 (23.12) 73 (26.11) 42 (22.07)

M (SD)/n (%)

(n = 246; 4.59%)

Class 4: Global Adversity

1,697 (29.25) 1,148 (20.95) 830 (15.61) 1,688 (34.20)

1,431 (22.65) 1,148 (22.23) 830 (31.91) 1,688 (23.20)

M (SD)/n (%)

Full Immigrant Sample

49.35***

22.20***

F/χ2 Significance

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Beyond duration, we were unable to examine differences in acculturation as the NESARC does not include acculturation-related items that can be used across multiple regions of origin. We also examined the region of origin across the four latent classes. Controlling for sociodemographic confounds we found that, with Class 1 (Limited Adverse Experience) as the reference class, immigrants from Africa were significantly less likely to be members of Class 2 (Child Emotional and Physical Abuse; ARR = 0.66, 95% CI = [0.59, 0.74]) and Class 3 (Child and Family Violence; ARR = 0.50, 95% CI = [0.28, 0.90]). African immigrants were, however, significantly more likely to be members of Class 4 (Global Adversity; ARR = 1.35, 95% CI = [1.26, 1.44]). A similar pattern was observed for immigrants from Asia who were significantly less likely to be members of Class 2 (ARR = 0.93, 95% CI = [0.89, 0.97]) and Class 3 (ARR = 0.79, 95% CI = [0.71, 0.88]), but significantly more likely to be members of Class 4 (Global Adversity; ARR = 1.40, 95% CI = [1.29, 1.52]). European immigrants were significantly more likely to be members of Class 2 (Child Emotional and Physical Abuse; ARR = 1.08, 95% CI = [1.02, 1.14]) and significantly less likely to be members of Classes 3 (Child and Family Violence; ARR = 0.72, 95% CI = [0.53, 0.97]) and 4 (Global Adversity; ARR = 0.80, 95% CI = [0.72, 0.89]).

DSM Disorders and Antisocial Behavior by Latent Class Table 3 presents the ARRs for the latent classes in contrast to the reference class (i.e., Limited Adverse Experience). Members of Classes 2 to 4 were significantly more likely to meet criteria for a DSM mental or substance use disorder and to report involvement in violence and non-violent crime. With the exception of other illicit drug use, the largest effects were consistently observed among members of Class 3 (Child and Family Abuse). Particularly large effects were observed for cannabis use disorder among members of Class 3 (ARR = 7.93, 95% CI = [5.89, 10.66]) as well as other illicit drug use among members of Class 4 (Global Adversity; ARR = 6.60, 95% CI = [5.52, 7.89]).

Discussion Heightened interest in extending research on the immigrant paradox has revealed notable findings indicating that despite greater disadvantage, immigrants are less likely to be diagnosed with mental health disorders, and engage in less crime and violence, and substance abuse (Butcher & Piehl, 2006; Escobar, 1998; Escobar et al., 2000; Hagan & Palloni, 1999; Lee et al., 2001; Martinez & Lee, 2000; Prado et al., 2009; Salas-Wright, Kagotho, & Vaughn,

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[2.10, 2.39] [2.14, 2.41] [2.36, 2.66] [2.17, 2.40] [1.88, 3.36] [2.66, 3.30] [2.47, 3.09] [2.18, 2.43]

2.28 2.51 2.96

2.76 2.30

(95% CI)

2.24 2.27 2.50

ARR

(n = 1,262; 23.53%)

3.85 3.50

2.45 7.93 4.58

3.10 3.81 3.96

ARR

[3.38, 4.38] [3.10, 3.94]

[2.16, 2.77] [5.89, 10.66] [2.54, 8.28]

[2.78, 3.45] [3.48, 4.16] [3.57, 4.38]

(95% CI)

(n = 358; 6.68%)

Class 3: Child and Family Violence

3.50 2.40

1.87 4.77 6.60

2.22 2.73 2.96

ARR

[3.24, 3.78] [2.04, 2.82]

[1.63, 2.15] [3.18, 7.16] [5.52, 7.89]

[2.01, 2.44] [2.54, 2.92] [2.75, 3.19]

(95% CI)

(n = 246; 4.59%)

Class 4: Global Adversity

Note. Reference class is Class 1: “Limited Adverse Experience” (n = 3,497; 65.21%). Adjusted risk ratios (ARR) adjusted for age, gender, race/ ethnicity, household income, marital status, region of the United States, and urbanicity. ARRs and 95% confidence intervals (CI) in bold are significant at p < .05. DSM = Diagnostic and Statistical Manual of Mental Disorders.

DSM mental disorders  Mood  Anxiety  Personality DSM substance use disorders  Alcohol  Cannabis   Other illicit drug Antisocial behavior  Violence   Non-violent crime





Class 2: Child Emotional and Physical Abuse

Table 3.  Adjusted Risk Ratios of DSM Disorders and Antisocial Behavior by Latent Class.

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2014; Salas-Wright & Vaughn, 2014; Salas-Wright, Vaughn, Clark, Terzis & Córdova, 2014; Stowell et al., 2009; Vaughn, Salas-Wright, DeLisi, & Maynard, 2014). The present study builds on this recent tradition and to our knowledge, is the largest study of ACE among immigrants vis-à-vis nativeborn Americans. Consistent with prior research on the immigrant paradox, we found that native-born Americans and second-generation immigrants were more likely to report physical and emotional abuse, witnessing domestic violence, and sexual abuse. One notable exception, however, was found for neglect. It seems quite plausible that behaviors deemed neglectful in the American cultural context such as doing chores that are difficult or dangerous, ignoring or failing to obtain medical treatment when sick or hurt, going hungry, and not having clothes, shoes, and school supplies are part and parcel of the deprivation of the lived experience in less advantaged cultural contexts and a motivating force for emigrating to the United States. Additional noteworthy findings surfaced when we examined the presence of latent subgroups. Although approximately two thirds of immigrants reported very limited ACE, three other latent classes were identified including a global adversity latent class that was composed of a significantly larger proportion of females and persons with less than a high school education. Other research has shown that immigrant families may place less value on the well-being of females, particularly if poorly educated (Jewkes, 2002; Raj & Silverman, 2002). Of critical interest is that, compared with those immigrants experiencing limited adversity, the three ACE classes were substantially more likely to be diagnosed with a DSM-based mood, personality, or substance use disorder. Violent and non-violent crime was also significantly more likely. Although particularly large effects were found for cannabis and other drug use disorders, in large measure, it did not matter what type of ACE latent class an immigrant was a member of as it was associated with increased probability of poor mental and behavioral health. Present study findings possess broad implications. First, and perhaps foremost, policies and practices that operate under an assumption (implicit or explicit) of increased risk of physical and sexual abuse and family violence among immigrants are likely to be flawed. Although few studies have investigated ACE among immigrants, the present population-based study clearly demonstrates this is not the case. However, neglect may be differentially perceived cross-culturally (or just a matter of pre-migration circumstances), and the American child welfare norms around neglect my come in conflict with the norms of some immigrants. Thus, future endeavors that target raising awareness about the lower levels of violence found in this and other studies among first-generation immigrants, which often contrast with depictions found in

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popular culture, are important in changing viewpoints and mitigating some of the xenophobia that acts as a barrier to rational immigrant policies. Although the present investigation possesses a number of assets, several important limitations are worth highlighting. One major limitation is the data are less than ideal with respect to temporal ordering. Thus, any causal determinations are not possible. Another major limitation is that we necessarily rely on retrospective and uncorroborated self-reported measures of ACE, and this approach has been shown to possess several limitations (Widom, 1989a, 1989b, 1991). To rectify these aforementioned limitations, prospective lifecourse study designs are needed. An additional limitation is that the data did not include important situational or contextual information on the immigrant experience, which could be revealing with regard to cultural circumstances. Immigrant families often find themselves in disadvantaged contexts. These contexts have been found to be associated with ACE in native-born U.S. samples. However, immigrants, despite the difficult circumstances in which they are often enmeshed, are less likely, except for neglect, to report ACE. Present study findings run counter to popular opinion and limited empirical research using non-representative samples on ACE among immigrants. As such, findings are consistent with recent extensions of the immigrant paradox to problem behaviors. The present study provides a useful baseline from which future studies can build on vis-à-vis ACE and immigrants. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by Grant Number R25 DA030310 (Principal Investigator [PI]: Anthony) from the National Institute on Drug Abuse at the National Institutes of Health.

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Author Biographies Michael G. Vaughn, PhD, is a professor in the School of Social Work at Saint Louis University. He has contributed more than 250 scholarly publications across a wide range of areas. His research interests include youth violence, adolescent psychopathy, and drug use and abuse in relation to antisocial behavior over the life course. Current projects include a cell-to-society approach to the study of human behavior, youth violence prevention, school dropout, and drug use epidemiology. Christopher P. Salas-Wright, PhD, is an assistant professor in the School of Social Work at the University of Texas at Austin. His research interests include youth problem behavior, religiosity and spirituality, and adolescent substance abuse and violence, particularly among Latino youth in the United States and in Latin America. Jin Huang, PhD, is an assistant professor in the School of Social Work at Saint Louis University. His research interests include poverty and child development and quantitative methods. Zhengmin Qian, MD, PhD, is a professor and the chair in the Department of Epidemiology, College of Public Health and Social Justice, Saint Louis University. His research interests include the effect of environmental sources of pollution on health and social epidemiology. Lauren D. Terzis, MSW, is a doctoral student at Saint Louis University. Her research interests involve immigrants and problem behaviors. Jesse J. Helton, PhD, is an assistant professor in the School of Social Work at Saint Louis University. His research interests include childhood adversity and health including obesity and studies of the child welfare system.

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Adverse Childhood Experiences Among Immigrants to the United States.

A growing number of studies have examined the "immigrant paradox" with respect to health behaviors in the United States. However, little research atte...
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