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Do safe, stable, and nurturing relationships work? New research has important findings for responding to ACEs


While we know that adverse childhood experiences (ACEs) can cause risk behaviors, research has told us that the presence of protective factors can help mitigate the effects of ACEs. Common risk behaviors such as smoking tobacco and alcohol misuse can be a result from the trauma of childhood disadvantage. In responding to ACEs, public health research proposes that protective factors such as safe, stable, nurturing relationships (SSNRs) with a caring adult can mitigate the long-term effects of ACEs, thus increasing resilience in children. 

In response to this, new research investigates whether the presence of an SSNR does reduce engagement in risk behaviors. By studying if tobacco and alcohol use would be weak or strong in adults whose basic living needs were met and felt safe and protected during childhood, the study further delved into the relationship between SSNRs and risk behaviors from ACEs (Srivastav, Davis, et al., 2020). This recent study revealed that these relationships do significantly decrease the odds of an adult engaging in unhealthy behaviors such as tobacco and alcohol use, further supporting SSNRs as playing a role in curbing risk behaviors. While SSNRs have proven to be effective, few studies have considered the inequities that racial minorities face and whether the presence of an SSNR is the best strategy for every population.

One study conducted in 2020 investigated this relationship between SSNRs and tobacco use among South Carolina adults and further examined the disproportionately worse health outcomes experienced by Black children and families (Srivastav, Strompolis, et al., 2020). The study found that SSNRs did not significantly buffer tobacco use among Black adults, whereas it did among White adults. 

Through this research, it is evident that protective factors such as SSNRs do have an impact on mitigating the long-term effects of ACEs. However, when examined by race, the effectiveness of SSNRs for minority children comes into question. It is important to consider the systemic racism and inequities faced by Black children that can cause strains in their relationships. Because of this study, SSNRs may not be sufficient to provide the support for racial/ethnic minorities who have been exposed to ACEs. Addressing the systemic racism in education, employment opportunities, health care, and housing to create equitable, tailored supports to addressing childhood trauma is important for the health and well-being of children of color. 


Srivastav, A., Davis, R. E., Strompolis, M., Crouch, E., Thrasher, J. F., & Spencer, M. (2020). Responding to Adverse Childhood Experiences: Understanding the Role of Safe, Stable, and Nurturing Relationships in Reducing Alcohol and Tobacco Related Risk Behaviors. Journal of Child & Adolescent Substance Abuse, 1-13.

Srivastav, A., Strompolis, M., Kipp, C., Richard, C. L., & Thrasher, J. F. (2020). Moderating the Effects of Adverse Childhood Experiences to Address Inequities in Tobacco-Related Risk Behaviors. Health Promotion Practice21(1_suppl), 139S-147S. 

Alyssa Koziarski, Children's Trust of South Carolina

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