American Indian adverse childhood experiences disparities in South Dakota: Results of the South Dakota Health Survey

Objectives: Adverse childhood experiences (ACEs) have been linked to negative physical and behavioral health consequences in numerous populations. However, research is needed to examine the impact of ACEs in American Indian (AI) populations. This study assessed the prevalence of ACEs and their association with health conditions in AI and non-AI populations in South Dakota (SD). 

Methods: The validated ACE questionnaire was included in a cross-sectional statewide health survey conducted in SD. We obtained approval from seven AI tribes in SD to include their reservation communities in the sample. Between November 2013 and October 2014 we administered mail, phone, and in-person surveys to a representative sample of 17,341 households, with oversampling in rural and reservation counties. We assessed differences in prevalence of ACEs between AI and non-AI populations and associations between ACEs and health conditions.

Results: 7,678 participants completed the survey, including 516 AIs. Compared to non-AIs, AIs display higher prevalence across all ACE dimensions of abuse, neglect, and household dysfunction as well as total number of ACEs experienced. For AIs, higher ACE scores resulted in significantly increased risk for depression (OR 1.48, p<0.01), anxiety (OR 1.42, p<0.01), and heart disease (OR 1.28, p=0.0093). 

Conclusions: AIs in SD experience disparities in ACEs that may contribute to poor health outcomes across the lifespan. Policies and programs to prevent and mitigate ACEs must account for significant disparities experienced by AI populations. While our findings from a single state are informative, the diversity of tribal and urban AI populations necessitates additional research on the impact of ACEs in these populations.