Primary Submission Category: Health care/services
Medical Mistrust and Adverse Childhood Experiences: Understanding Age-Specific Patterns in Black Women’s Healthcare Access
Authors: April Bell, Angela Wiley, Cheryl Moyer, Sativa Banks, Leslie Schneider, Sirry Alang,
Presenting Author: April Bell*
Context and Objective
Mistrust in healthcare systems, shaped by historical and systemic inequities, poses a significant barrier to care for Black women. Adverse Childhood Experiences (ACEs) have been linked to mistrust, but the interplay between age, ACEs, and mistrust remains underexplored. This study aims to examine how ACEs influence mistrust among Black women to inform targeted, trauma-informed interventions.
Setting and Population
This study utilized demographic and survey data from Black women across three age categories: younger adults (18-24), middle-aged adults (25-44), and older adults (45+). The data included healthcare access patterns, mistrust scores, and ACE assessments, allowing for the analysis of both individual and systemic factors influencing mistrust.
Study Design
This is a cross-sectional analysis using self-reported data on healthcare usage, ACE scores, and mistrust levels. Linear regression models evaluated the relationship between ACEs and mistrust, with age group as a moderating factor. Additional descriptive statistics and correlation analyses were used to identify trends in healthcare utilization and demographic patterns.
Outcomes and Results
The linear regression model examining the effect of age group and ACE score on medical mistrust was statistically significant, F(3, 434) = 8.26, p < .001, and explained 5.4% of the variance in medical mistrust (R^2 = .054, adjusted R^2 = .048). Mistrust was highest among younger adults (18-24) and declined significantly with age, with older adults (45+) exhibiting the lowest mistrust scores (p < 0.001). Higher ACE scores were associated with increased mistrust across all age groups, with the strongest effect observed in younger adults. ACEs had a weaker influence on mistrust in the 45+ group, likely due to cumulative resilience and longer-term relationships with healthcare providers. Younger adults also demonstrated greater reliance on emergency care, correlating with higher mistrust levels. In contrast, older adults predominantly utilized primary care, reflecting greater stability in care access and lower mistrust.
Conclusions
The findings highlight the compounding effects of ACEs and mistrust on healthcare utilization among younger Black women. Trauma-informed and age-specific interventions are crucial to address mistrust and promote equitable healthcare engagement. Early intervention for younger adults and sustained trust-building measures for older adults are essential to mitigating the long-term impacts of ACEs on healthcare relationships.