Neighborhood socioeconomic contexts mediate the association between adverse childhood experiences and social risk and health outcomes in adulthood

Although childhood adversity's long-term effects on health are well recognized, few studies examine how community-level conditions shape the relationships between adverse childhood experiences (ACEs) and social risk and health outcomes in adulthood. Understanding these relationships can inform targeted, place-based interventions to improve health and social risk outcomes decades after ACEs exposure. This study explored how neighborhood socioeconomic contexts influence the relationships between childhood adversity and adulthood social risk and health outcomes. Using data from the 2021 California Health Interview Survey (CHIS), we analyzed a sample of 18,612 adults, representative of California's adult population. The Karlson-Holm-Breen (KHB) method decomposed childhood adversity's effects into direct and indirect effects mediated by neighborhood socioeconomic contexts in adulthood. Findings indicated higher ACE scores were associated with increased housing and food insecurity, and poorer self-rated health, particularly among individuals with four or more ACEs. The neighborhood socioeconomic context mediated a small but significant portion of the relationship between ACEs and the outcomes. Policy initiatives addressing ACEs should consider the importance of neighborhood contexts in addressing social risk and health outcomes.