Racial and Ethnic Differences in Patient-Reported Acceptability of Adverse Childhood Experience (ACE) Screening in Adult Primary Care

Abstract

Background: Given the dose-response relationship between adverse childhood experiences (ACEs) and worse health outcomes, there has been a growing push for routine ACE screening in healthcare settings.

Objective: This study explored differences in patient-reported acceptability of ACE screening among adult primary care patients.

Participants and setting: Participants were adult primary care patients at an academic safety-net internal medicine clinic. Of the 136 patients who elected to participate in this study, 131 (96%) submitted completed surveys.

Methods: Adult primary care patients at an academic safety-net internal medicine clinic completed an ACE screener and follow-up survey assessing their reported acceptability of ACE screening. Patients were also asked to specify their race, ethnicity, gender, and age. Chi-square analysis and Fisher's exact tests were used to examine associations between variables.

Results: Among 131 patients, 37% reported 4 or more ACEs. Black/African American patients and Hispanic/Latinx patients were overrepresented in the high ACE score (4 +) group (p < 0.05). Over one in three of all patients did not find ACE screening to be an acceptable part of their primary care. After a Bonferroni adjustment, patient-reported acceptability was not statistically associated with patients' ACE score or patients' race, ethnicity, gender, or age. Notably, however, in our small sample of Native American and Hispanic/Latino patients, over half did not find ACE screening to be acceptable.

Conclusions: There is insufficient evidence to conclude that patients find ACE screening to be an acceptable part of their primary care. Our study is the first to explore how patient-reported acceptability may vary with patient demographics. While our findings revealed no significant associations between patient demographics and acceptability, trends observed within our study suggest that future studies with larger and more representative samples are needed. We consider routine ACE screening to be unsubstantiated and premature, and instead encourage the development of comprehensive trauma-informed practices for which a disclosure of childhood adversity is not necessary.

Keywords: Acceptability; Adverse childhood experience (ACE) screening; Adverse childhood experiences (ACEs); Childhood trauma; Trauma-informed care (TIC).