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Abstract
A strong body of research connects Adverse Childhood Experiences (ACEs) with poor adult health and mental health outcomes. Since the seminal study in 1998 that correlated ACEs to poor physical and mental health in adulthood, the relationship between early adversity and subsequent health problems has been consistently replicated in numerous populations and locales. However, few studies have focused on the relationship of ACEs to health care access in adulthood. In 2012, survey and electronic medical record data from 354 patients were collected at three primary care clinics in the Midwest. The relationship between the number of ACEs and measures of health care access, health literacy, health insurance status and gaps in coverage, regular medical care, and medical debt were examined. Individuals who experienced more categories of ACEs were more likely to experience challenges in accessing health care. Regression analysis was used to examine the relationships between health care access and ACEs. Health care barriers are significantly and positively associated with higher ACE scores, regular health care as a child, age, ethnicity, and material hardship. Implications of these findings will assist with identifying patients within primary care settings who are likely to experience interruptions in care and difficulty accessing care. Individuals with higher ACEs scores would likely benefit from special, enhanced health literacy interventions. Social work will play an important role in the delivery of such interventions in designated medical homes through integrated primary care.
Keywords: adverse childhood events, health care access, social work and health
Introduction
The relationship between ACEs and measures of health care access, health literacy, health insurance status and gaps in coverage, regular medical care, and medical debt were examined in a sample of patients from primary care settings. Findings replicated previous research documenting the strong connections between childhood adversity and adult health. Individuals who experience more ACEs were more likely to experience challenges in accessing health care in adulthood. Those with higher ACEs scores were significantly more likely than those with lower ACE scores to experience medical debt, were less likely to be insured, were more likely to experience gaps in their health care coverage, and have lower levels of health literacy. Further, those with higher ACE scores were significantly more likely to go without medical care due to...