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Stirling J, Gavril A, Brennan B, Sege RD, Dubowitz H. The Pediatrician's Role in Preventing Child Maltreatment: Clinical Report. Pediatrics 2024; 154:e2024067608. [PMID: 39034825 DOI: 10.1542/peds.2024-067608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/23/2024] Open
Abstract
Pediatricians have always seen the value of preventing health harms; this should be no less true for child maltreatment than for disease or unintentional injuries. Research continues to demonstrate that maltreatment can be prevented, underscoring the vital roles of both the family and society in healthy childhood development and the importance of strong, stable, nurturing relationships in preventing maltreatment and building the child's resilience to adversity. This clinical report elaborates the pediatrician's multitiered role in supporting relational health from infancy through adolescence, from universal interventions assessing for maltreatment risks and protective factors to targeted interventions addressing identified needs and building on strengths. When maltreatment has already occurred, interventions can prevent further victimization and mitigate long-term sequelae. Advice is provided on engaging community resources, including those that provide food, shelter, or financial support for families in need.
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Affiliation(s)
| | - Amy Gavril
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Brian Brennan
- The Armed Forces Center for Child Protection, Walter Reed National Military Medical Center, Bethesda, Maryland. The views expressed in this presentation are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government
| | - Robert D Sege
- Departments of Medicine and Pediatrics, Tufts University School of Medicine, Center for Community Engaged Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Howard Dubowitz
- Division of Child Protection, Center for Families, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Bates RA, Dynia JM. Psychological and Physiological Stress and Stressors in Early Childhood Educators: An Observational Pilot Study. PSYCHOLOGY IN THE SCHOOLS 2024; 61:1413-1439. [PMID: 38933217 PMCID: PMC11198965 DOI: 10.1002/pits.23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/21/2023] [Indexed: 06/28/2024]
Abstract
While early childhood educators' mental health is important, it may also affect the well-being and education of their students. Yet, little research has described the stress and stressors of early childhood educators (ECEs), particularly as the pandemic wanes. This pilot study aimed to (1) describe ECEs' psychological and physiological stress and (2) examine the association between ECEs' psychological and physiological stress levels with stressors. A convenience sample of 67 ECEs, serving children 0-5 years old from 13 early educational centers completed surveys on psychological stress (perceived stress, anxiety, and depression), stressors (economic hardship, food insecurity, adverse childhood experiences), and demographics in Fall 2021. A subsample of ECEs provided hair samples, analyzed for cortisol, to estimate physiologic stress. Regarding stress, 63% met the criteria for major depressive disorder and 41% for generalized anxiety disorder. Only 26% were taking medications to manage mental health. About 25% experienced the stressors of food insecurity and economic hardship; 80% experienced at least one adverse childhood experience. Only education level significantly predicted perceived stress and depression - above and beyond stressors, household income, race, and age. The results have policy and practice implications for implementing evidence-based solutions to buffer stress and stressors in early childhood educators.
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Affiliation(s)
- Randi A. Bates
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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Lê-Scherban F, Wang A, Courts KA, Ettinger de Cuba S, Wade R, Chilton M. A Short Adverse Experiences Measure Among Mothers of Young Children. Pediatrics 2024; 153:e2023063882. [PMID: 38449423 DOI: 10.1542/peds.2023-063882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department. METHODS From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression. RESULTS Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes. CONCLUSIONS A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics
- Drexel Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Anqi Wang
- Department of Epidemiology and Biostatistics
| | - Kelly A Courts
- Department of Epidemiology and Biostatistics
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Stephanie Ettinger de Cuba
- Boston University School of Public Health and Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Roy Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Casas-Muñoz A, Velasco-Rojano ÁE, Rodríguez-Caballero A, Prado-Solé E, Álvarez MG. ACE-IQ extended version validation and ACE's frequency in Mexican adolescents. CHILD ABUSE & NEGLECT 2024; 150:106492. [PMID: 37805276 DOI: 10.1016/j.chiabu.2023.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) may have short, middle, and long-term consequences on people's development and physical and mental health. There is a need for information on this subject in low- and middle-income countries and a need to reduce recall bias in ACEs research worldwide. OBJECTIVE Hence our objectives were to translate, adapt and validate the Adverse Childhood Experiences extended version and to determine ACEs frequencies in a sample of Mexican adolescents. PARTICIPANTS AND SETTING A convenience sample of 5835 schooled Mexican adolescents (age: M = 16.13, SD = 1.32; 61.01 % females) from 20 states in Mexico completed a survey. METHOD A cross-sectional study was conducted with an extended version of the ACE-International Questionnaire (ACE-IQ), which assesses 23 ACEs organized into five categories: situations that cause household dysfunction, exposure to violence, violence from parents or guardians, interpersonal violence, and sociodemographic context. RESULTS Evidence of construct validity and reliability of the questionnaire was obtained, and 16 ACEs were included in the final ACE-IQ version. 90 % of adolescents had one or more ACEs. Neglect was the most experienced ACE reported by 73.30 % of the participants, with no significant difference by age, sex, or geographic region. CONCLUSION ACE-IQ questionnaire is a reliable and valid instrument to recommend its use for generating information on ACEs in studies on Mexican adolescents. The results on the frequency of ACEs revealed that 90 % of this schooled Mexican adolescent sample had experienced one or more ACEs, and about a third had experienced six or more.
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Affiliation(s)
- Abigail Casas-Muñoz
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México
| | - Ángel Eduardo Velasco-Rojano
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México.
| | - Aarón Rodríguez-Caballero
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México
| | - Eva Prado-Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, México
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Muñoz AC, Rojano ÁEV, Caballero AR, Solé EP, Álvarez MG. Reprint of: Associations between mental health problems and Adverse Childhood Experiences ACEs in indigenous and non-indigenous Mexican adolescents. CHILD ABUSE & NEGLECT 2024; 148:106639. [PMID: 38242770 DOI: 10.1016/j.chiabu.2024.106639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have long-term consequences. The ACEs model has been extensively used in high-income countries. However, its effectiveness has yet to be demonstrated in low and middle-income countries and marginalized social groups. In indigenous populations, research has found inconsistent results in the prevalence and the relationship between ACEs and mental health outcomes. Therefore, the objectives of this study were 1) to determine the ACEs frequency among indigenous and non-indigenous Mexican adolescents; 2) to test the association between ACE scores and symptoms of Mental Health Problems (SMHP) in both groups; and 3) to review the ACEs model adequacy for the indigenous adolescents. PARTICIPANTS AND SETTINGS Data from an online survey in 20 of the 32 states of Mexico were analyzed. We selected an 87 adolescent sample from indigenous families and 174 non-indigenous matched for age, sex, and state of residence, with a mean age of 16 years; 60 % were women. METHODS ACE-IQ questionnaire and Youth Self Report instrument (eight SMHP) were used to collect data. ACEs' frequency was analyzed for each group, and Pearson correlations were used to identify the relationship between ACEs and SMHP. RESULTS There was no statistical significance between Indigenous and non-Indigenous adolescents in the ACEs report. ACE scores were associated with eight SMHP. Correlations between ACE score and SMHP were higher in non-indigenous adolescents. CONCLUSIONS ACEs were experienced similarly by both groups and were associated with mental health in all participants. Further research is needed to improve ACEs measurement in indigenous populations.
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Affiliation(s)
- Abigail Casas Muñoz
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Ángel Eduardo Velasco Rojano
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Aarón Rodríguez Caballero
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Eva Prado Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, Mexico
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Adam-Troian J, Bélanger JJ. "Consumed by creed": Obsessive-compulsive symptoms underpin ideological obsession and support for political violence. Aggress Behav 2024; 50:e22124. [PMID: 37961930 DOI: 10.1002/ab.22124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
Radicalization is a process by which individuals are introduced to an ideological belief system that encourages political, religious, or social change through the use of violence. Here we formulate an obsessive-compulsive disorder (OCD) model of radicalization that links obsessive passion (OP; one of the best predictors of radical intentions) to a larger body of clinical research. The model's central tenet is that individual differences in OCD symptom severity could shape radical intentions via their influence on OP. Across four ideological samples in the United States (Environmental activists, Republicans, Democrats, and Muslims, Ntotal = 1114), we found direct effects between OCD symptom severity and radical intentions, as well as indirect effects of OCD on radical intentions via OP. Even after controlling for potential individual difference and clinical confounds (e.g., adverse childhood experiences, loss of significance, and substance abuse), these relationships remained robust, implying that OCD plays a significant role in the formation of violent ideological intentions and opening new avenues for the treatment and prevention of violent extremism. We discuss the implications of conceptualizing radicalization as an OCD-like disorder with compulsive violent tendencies and ideology-related concerns.
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Affiliation(s)
| | - Jocelyn J Bélanger
- Department of Arts and Sciences, Carnegie-Mellon University, Doha, Qatar
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Muñoz AC, Rojano ÁEV, Caballero AR, Solé EP, Álvarez MG. Associations between mental health problems and Adverse Childhood Experiences ACEs in indigenous and non-indigenous Mexican adolescents. CHILD ABUSE & NEGLECT 2024; 147:106595. [PMID: 38061280 DOI: 10.1016/j.chiabu.2023.106595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have long-term consequences. The ACEs model has been extensively used in high-income countries. However, its effectiveness has yet to be demonstrated in low and middle-income countries and marginalized social groups. In indigenous populations, research has found inconsistent results in the prevalence and the relationship between ACEs and mental health outcomes. Therefore, the objectives of this study were 1) to determine the ACEs frequency among indigenous and non-indigenous Mexican adolescents; 2) to test the association between ACE scores and symptoms of Mental Health Problems (SMHP) in both groups; and 3) to review the ACEs model adequacy for the indigenous adolescents. PARTICIPANTS AND SETTINGS Data from an online survey in 20 of the 32 states of Mexico were analyzed. We selected an 87 adolescent sample from indigenous families and 174 non-indigenous matched for age, sex, and state of residence, with a mean age of 16 years; 60 % were women. METHODS ACE-IQ questionnaire and Youth Self Report instrument (eight SMHP) were used to collect data. ACEs' frequency was analyzed for each group, and Pearson correlations were used to identify the relationship between ACEs and SMHP. RESULTS There was no statistical significance between Indigenous and non-Indigenous adolescents in the ACEs report. ACE scores were associated with eight SMHP. Correlations between ACE score and SMHP were higher in non-indigenous adolescents. CONCLUSIONS ACEs were experienced similarly by both groups and were associated with mental health in all participants. Further research is needed to improve ACEs measurement in indigenous populations.
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Affiliation(s)
- Abigail Casas Muñoz
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Ángel Eduardo Velasco Rojano
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Aarón Rodríguez Caballero
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Eva Prado Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, Mexico
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Trockel MT, West CP, Dyrbye LN, Sinsky CA, Tutty M, Wang H, Carlasare LE, Menon NK, Shanafelt TD. Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians. Mayo Clin Proc 2023; 98:1785-1796. [PMID: 38043996 DOI: 10.1016/j.mayocp.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. PARTICIPANTS AND METHODS We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. RESULTS Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. CONCLUSION Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.
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Affiliation(s)
- Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
| | - Colin P West
- Department of Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Aurora, IL
| | - Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Michael Tutty
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Hanhan Wang
- WellMD & WellPhD Center, Stanford University School of Medicine, Palo Alto, CA
| | - Lindsey E Carlasare
- Health Care Research and Policy Analysis, American Medical Association, Chicago, IL
| | - Nikitha K Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
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Collender P, Bozack AK, Veazie S, Nwanaji-Enwerem JC, Van Der Laan L, Kogut K, Riddell C, Eskenazi B, Holland N, Deardorff J, Cardenas A. Maternal adverse childhood experiences (ACEs) and DNA methylation of newborns in cord blood. Clin Epigenetics 2023; 15:162. [PMID: 37845746 PMCID: PMC10577922 DOI: 10.1186/s13148-023-01581-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) increase the risk of poor health outcomes later in life. Psychosocial stressors may also have intergenerational health effects by which parental ACEs are associated with mental and physical health of children. Epigenetic programming may be one mechanism linking parental ACEs to child health. This study aimed to investigate epigenome-wide associations of maternal preconception ACEs with DNA methylation patterns of children. In the Center for the Health Assessment of Mothers and Children of Salinas study, cord blood DNA methylation was measured using the Illumina HumanMethylation450 BeadChip. Preconception ACEs, which occurred during the mothers' childhoods, were collected using a standard ACE questionnaire including 10 ACE indicators. Maternal ACE exposures were defined in this study as (1) the total number of ACEs; (2) the total number of ACEs categorized as 0, 1-3, and > 4; and (3) individual ACEs. Associations of ACE exposures with differential methylated positions, regions, and CpG modules determined using weighted gene co-expression network analysis were evaluated adjusting for covariates. RESULTS Data on maternal ACEs and cord blood DNA methylation were available for 196 mother/newborn pairs. One differential methylated position was associated with maternal experience of emotional abuse (cg05486260/FAM135B gene; q value < 0.05). Five differential methylated regions were significantly associated with the total number of ACEs, and 36 unique differential methylated regions were associated with individual ACEs (Šidák p value < 0.05). Fifteen CpG modules were significantly correlated with the total number of ACEs or individual ACEs, of which 8 remained significant in fully adjusted models (p value < 0.05). Significant modules were enriched for pathways related to neurological and immune development and function. CONCLUSIONS Maternal ACEs prior to conception were associated with cord blood DNA methylation of offspring at birth. Although there was limited overlap between differential methylated regions and CpGs in modules associated with ACE exposures, statistically significant regions and networks were related to genes involved in neurological and immune function. Findings may provide insights to pathways linking psychosocial stressors to health. Further research is needed to understand the relationship between changes in DNA methylation and child health.
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Affiliation(s)
- Phillip Collender
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Anne K Bozack
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Research Park, 1701 Page Mill Road, Stanford, CA, 94304, USA
| | - Stephanie Veazie
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Jamaji C Nwanaji-Enwerem
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Lars Van Der Laan
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Katherine Kogut
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA, USA
| | - Corinne Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Brenda Eskenazi
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA, USA
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Nina Holland
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA, USA
| | - Julianna Deardorff
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA, USA
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Andres Cardenas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Research Park, 1701 Page Mill Road, Stanford, CA, 94304, USA.
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Jordan EJ, Shih PC, Nelson EJ, Carter SJ, Schootman M, Prather AA, Yao X, Peters CD, Perry CSE. Ecological Momentary Assessment of Midlife Adults' Daily Stress: Protocol for the Stress Reports in Variable Environments (STRIVE) App Study. JMIR Res Protoc 2023; 12:e51845. [PMID: 37796561 PMCID: PMC10587811 DOI: 10.2196/51845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Daily stressors are associated with cognitive decline and increased risk of heart disease, depression, and other debilitating chronic illnesses in midlife adults. Daily stressors tend to occur at home or at work and are more frequent in urban versus rural settings. Conversely, spending time in natural environments such as parks or forests, or even viewing nature-themed images in a lab setting, is associated with lower levels of perceived stress and is hypothesized to be a strong stress "buffer," reducing perceived stress even after leaving the natural setting. However, many studies of daily stress have not captured environmental contexts and relied on end-of-day recall instead of in-the-moment data capture. With new technology, these limitations can be addressed to enhance knowledge of the daily stress experience. OBJECTIVE We propose to use our novel custom-built Stress Reports in Variable Environments (STRIVE) ecological momentary assessment mobile phone app to measure the experience of daily stress of midlife adults in free-living conditions. Using our app to capture data in real time will allow us to determine (1) where and when daily stress occurs for midlife adults, (2) whether midlife adults' daily stressors are linked to certain elements of the built and natural environment, and (3) how ecological momentary assessment measurement of daily stress is similar to and different from a modified version of the popular Daily Inventory of Stressful Events measurement tool that captures end-of-day stress reports (used in the Midlife in the United States [MIDUS] survey). METHODS We will enroll a total of 150 midlife adults living in greater Indianapolis, Indiana, in this study on a rolling basis for 3-week periods. As those in underrepresented minority groups and low-income areas have previously been found to experience greater levels of stress, we will use stratified sampling to ensure that half of our study sample is composed of underrepresented minorities (eg, Black, American Indian, Hispanic, or Native Pacific Islanders) and approximately one-third of our sample falls within low-, middle-, and high-income brackets. RESULTS This project is funded by the National Institute on Aging from December 2022 to November 2024. Participant enrollment began in August 2023 and is expected to finish in July 2024. Data will be spatiotemporally analyzed to determine where and when stress occurs for midlife adults. Pictures of stressful environments will be qualitatively analyzed to determine the common elements of stressful environments. Data collected by the STRIVE app will be compared with retrospective Daily Inventory of Stressful Events data. CONCLUSIONS Completing this study will expand our understanding of midlife adults' experience of stress in free-living conditions and pave the way for data-driven individual and community-based intervention designs to promote health and well-being in midlife adults. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51845.
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Affiliation(s)
- Evan J Jordan
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Patrick C Shih
- Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States
| | - Erik J Nelson
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - Stephen J Carter
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Aric A Prather
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Xing Yao
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
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Mumford EA, Copp J, MacLean K. Childhood Adversity, Emotional Well-Being, Loneliness, and Optimism: a National Study. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:137-149. [PMID: 36466586 PMCID: PMC9684794 DOI: 10.1007/s42844-022-00084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 05/05/2023]
Abstract
Optimism and loneliness, which reflect the expected inverse associations with excess morbidity and mortality, are theoretically and empirically associated with early adversities and offer potential avenues for clinical support. The current study first estimates latent classes of adverse childhood experiences and, second, assesses the role of these experiences on later reports of optimism and loneliness in late adolescence and emerging adulthood, and the role of emotional regulation and common mental disorders. Surveys were conducted in a longitudinal household sample of adolescents recruited in 2013 (average age of 20 at wave 6 follow-ups). The analytic sample included 1177 female and male respondents representative of their age group in the USA at baseline. Latent classes were estimated based on 10 indicators of childhood adversity. Respondents were assigned to classes using posterior probabilities of latent class membership, and class membership was used to predict psychological outcomes in multivariable models. Three latent classes of childhood adversity were identified in the current sample, representing low childhood adversity (81.5%), higher probability of family dysfunction with lower levels of interpersonal abuse (13.4%), and high adversity including higher probabilities of parental discord and violence as well as child abuse (5.1%). Both classes of respondents who faced greater childhood adversity were more likely to report greater loneliness and lower optimism in emerging adulthood. Results were attenuated by measures of emotional well-being. Addressing adolescent loneliness and supporting optimistic outlooks in emerging adulthood are two pathways with potential benefits to reduce mental and physical morbidities.
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Affiliation(s)
- Elizabeth A. Mumford
- NORC at the University of Chicago, 4350 East-West Highway, Suite 800, Bethesda, MD 20814 USA
| | - Jennifer Copp
- Florida State University, 314B Criminology & Criminal Justice Building, 112 S. Copeland Street, Tallahassee, FL 32306-1273 USA
| | - Kai MacLean
- NORC at the University of Chicago, 4350 East-West Highway, Suite 800, Bethesda, MD 20814 USA
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Baishya ML, Martinasek M, Bell L, Wheldon CW. Adverse Childhood Experiences and Adult Tobacco Use Among Sexual and Gender Minority Populations: Examining the Role of Mental, Social, and Community Health. LGBT Health 2022; 10:211-219. [PMID: 36520611 DOI: 10.1089/lgbt.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: We sought to evaluate the relationship between adverse childhood experiences (ACEs) and tobacco use, to assess the intersection of sexual orientation or gender identity (SOGI), and to explore risk and protective aspects of mental, social, and community health. Methods: This was a secondary analysis of the sexual and gender minorities (SGM) subsample (n = 1102) from a 2019 Community Health Needs Assessment. Nested binary logistic regression models were created to evaluate associations between ACEs and type of tobacco use: (1) cigarette use versus no cigarette or electronic nicotine delivery systems (ENDS) use, (2) ENDS use versus no cigarette or ENDS use, and (3) dual use versus use of either cigarettes or ENDS. Results: The sample population that reported four or more ACEs and ENDS use had statistically significant adjusted odds ratios (aORs) when adjusting the models for sociodemographic variables (aOR = 2.55; 95% confidence intervals [CIs]: 1.54-4.22), SOGI (aOR = 2.44; 95% CI: 1.46-4.10), current mental health (aOR = 2.23; 95% CI: 1.32-3.75), and social and community health (aOR = 2.19; 95% CI: 1.30-3.71). The sample population that reported poor mental health had statistically significant aORs when adjusting the models for sociodemographic variables, SOGI, and mental health (aOR = 2.26; 95% CI: 1.32-3.89) and social and community health (aOR = 2.06; 95% CI: 1.17-3.54). There was no statistically significant finding related to the other tobacco use variables (tobacco use and dual use). Conclusion: We found that high-risk ACEs were positively associated with cigarette use and ENDS use. SGM populations have differing experiences when considering community and social support.
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Affiliation(s)
- Mona L. Baishya
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Mary Martinasek
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida, USA
| | - Lisa Bell
- Community Benefit, BayCare Health System, Clearwater, Florida, USA
| | - Christopher W. Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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Fekih-Romdhane F, Dabbous M, Hallit R, Malaeb D, Sawma T, Obeid S, Hallit S. Development and validation of a shortened version of the Child Abuse Self Report Scale (CASRS-12) in the Arabic language. Child Adolesc Psychiatry Ment Health 2022; 16:100. [PMID: 36494699 PMCID: PMC9737702 DOI: 10.1186/s13034-022-00533-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND All available scales to screen for child abuse may be challenging to administer due to their length. Indeed, a higher number of items is associated with more administration time and less motivation to engage in responding. We aimed through this study to examine the psychometric properties of a brief Arabic version of the Child Abuse Self Report Scale (CASRS-12) in terms of factorial structure, internal consistency, divergent validity, and correlations with measures of bullying victimization, eating attitudes and perceived social support. METHODS We performed a cross-sectional, web-based study among Community Lebanese adolescents; where two samples have been used (Sample 1: N = 852, aged 15.34 ± 1.18 years, 54.8% females; Sample 2: N = 404, aged 16.60 ± 1.51 years, 57.2% females). The construct validity was tested using both exploratory and confirmatory factor analyses. RESULTS Results revealed that both EFA and CFA yielded a four-factor structure for the CASRS-12 that mirrors the original four factors captured by the original CASRS. The scale also showed a good internal consistency as evidenced through McDonald's ω values ranging from 0.87 to 0.93 for the four subscales; and configural, metric, and scalar invariance across gender. Finally, we found that all CASRS-12 dimensions were significantly and positively correlated with more inappropriate eating attitudes and lower social support; and that psychological, physical, and sexual abuse correlated with higher bullying victimization CONCLUSION: In light of these findings, we potentially encourage clinicians and researchers to use this scale as a valid and reliable measure of child abuse among Arabic-speaking populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, 2010 Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mariam Dabbous
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Rabih Hallit
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon ,Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon ,Department of Infectious Disease, Notre Dame des Secours University Hospital, Byblos, Postal Code 3 Lebanon
| | - Diana Malaeb
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon ,grid.411884.00000 0004 1762 9788College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Toni Sawma
- grid.411323.60000 0001 2324 5973School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,Applied Science Research Center, Applied Science Private University, Amman, Jordan. .,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
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14
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Mumford EA, Taylor BG, Borowiecki M, Maitra P. Daily Reports of Aggressive Behaviors in Interpersonal Conflicts. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP21850-NP21874. [PMID: 34961387 DOI: 10.1177/08862605211063003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Interpersonal conflicts are inevitable, but the probability that conflicts involve aggressive behavior varies. Prior research that has tended to focus on victimization in intimate partnerships reported through retrospective designs. Addressing these limitations, the current study examines daily reports of behaving aggressively in any conflict across relationships in a sample of 512 young adults drawn from the nationally representative iCOR cohort. Respondent attitudes and affective measures were collected at the end of the daily data collection period. Regression methods were applied to examine the probability and frequency of aggression, investigating early and recent exposure to adversities, attitudes, self-control, affect and emotional states, and alcohol use behavior. Recent adversities and the propensity to endorse a defensive honor code attitude, consistent with theory and retrospective studies of aggression, predicted both prevalence and frequency of aggressive behavior. The associations of childhood maltreatment and self-control with the prevalence of behaving aggressively were as expected, but these constructs were significantly associated with the frequency of aggression with unexpected, inverse directionality. Moreover, respondents' affect and other emotional states were only associated with the frequency, not the prevalence, of aggressive behavior. Overall, this daily data collection constructively distinguished risk and protective factors for behaving aggressively more often. Further research is needed to disentangle the extent to which affective states drive or is a consequence of frequent aggressive behavior.
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Affiliation(s)
- Elizabeth A Mumford
- Statistics and Data Science, NORC at the University of Chicago, Bethesda, MA, USA
| | - Bruce G Taylor
- Statistics and Data Science, NORC at the University of Chicago, Bethesda, MA, USA
| | - Mateusz Borowiecki
- Statistics and Data Science, NORC at the University of Chicago, Bethesda, MA, USA
| | - Poulami Maitra
- Statistics and Data Science, NORC at the University of Chicago, Bethesda, MA, USA
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Abstract
OBJECTIVES Adverse childhood experiences (ACEs) including physical, emotional, or sexual abuse; neglect; and/or exposure to household instability have been associated with adult emergency department utilization, but the impact of parental ACEs on pediatric emergency department (PED) utilization has not been studied. The primary aim was to determine if parental ACEs impact resource utilization as measured by (1) frequency of PED utilization, (2) acuity of PED visits, and (3) 72-hour PED return rates. The secondary aim was to determine if resilience interacts with the impact of parental ACEs on PED utilization. METHODS This study is a cross-sectional survey using previously validated measures of ACEs, resiliency, and social determinants of health screening. Surveys were administered from October 17, 2019, to November 27, 2019, via iPad by research assistants in our institution's PEDs. Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson correlation was used to identify correlation between ACEs, social determinants of health, and PED utilization measures. RESULTS A total of 251 parents had complete data. Parental ACEs were positively associated with frequency of PED visits (incidence rate ratio, 1.013). In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits and were associated with fewer 72-hour return visits (incidence rate ratio, 0.49). CONCLUSIONS Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.
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Ng IYH, Tan ZH, Chua V, Cheong A. Separate Lives, Uncertain Futures: Does Covid-19 Align or Differentiate the Lives of Low- and Higher-Wage Young Workers? APPLIED RESEARCH IN QUALITY OF LIFE 2022; 17:3349-3380. [PMID: 35669586 PMCID: PMC9156360 DOI: 10.1007/s11482-022-10068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
With labour markets already polarised in industrialised economies, if Covid-19 worsens this polarity, young people could be more severely affected. This is because their entry into a post-pandemic economy has ramifications for their divergent or convergent career trajectories far into the future. Therefore, on the premise that work life is central to quality of life, this article assesses the effects of low wage and Covid-19 on the psychological outlook of young people in Singapore. We found that Covid-19 did worsen polarisation. On average, higher wage workers telecommuted more and had more work, but low wage young workers bore the brunt of earnings loss and job disruption. Low wage respondents also experienced poorer psychological well-being, even after adverse child experiences, highest educational qualification and occupation type were controlled for. However, higher wage workers might be more psychologically affected by the Covid-19 impacts. This might be because low earning workers are more accustomed to employment instability. These findings suggest the urgency of policy attention to help low wage young workers recover from Covid-19.
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Affiliation(s)
- Irene Y. H. Ng
- Social Service Research Centre and Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, The Shaw Foundation Building, Blk AS7, #03-22, Singapore, 117570 Singapore
| | - Zhi Han Tan
- Social Service Research Centre, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Vincent Chua
- Department of Sociology and Centre for Family and Population Research, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Annie Cheong
- Social Service Research Centre, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
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Dickson KS, Holt T, Arredondo E. Applying Implementation Mapping to Expand a Care Coordination Program at a Federally Qualified Health Center. Front Public Health 2022; 10:844898. [PMID: 35400046 PMCID: PMC8987275 DOI: 10.3389/fpubh.2022.844898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background A large and growing percentage of medically underserved groups receive care at federally qualified health centers (FQHCs). Care coordination is an evidence-based approach to address disparities in healthcare services. A partnered FQHC established a care coordination model to improve receipt and quality of healthcare for patients most at risk for poor health outcomes. This care coordination model emphasizes identification and support of behavioral health needs (e.g., depression, anxiety) and two evidence-based behavioral health programs needs were selected for implementation within the context of this care coordination model. Implementation Mapping is a systematic process for specifying the implementation strategies and outcomes. The current case study describes the application of Implementation Mapping to inform the selection and testing of implementation strategies to improve implementation of two behavioral health programs in a Care Coordination Program at a partnered FQHC. Methods We applied Implementation Mapping to inform the development, selection and testing of implementation strategies to improve the implementation of two evidence-based behavioral health programs within a care coordination program at a partnered FQHC. Results Results are presented by Implementation Mapping task, from Task 1 through Task 5. We also describe the integration of additional implementation frameworks (The Consolidated Framework for Implementation Research, Health Equity Implementation Framework) within the Implementation Mapping process to inform determinant identification, performance and change objectives development, design and tailoring of implementation strategies and protocols, and resulting evaluation of implementation outcomes. Conclusions The current project is an example of real-world application of Implementation Mapping methodology to improve care outcomes for a high priority population that is generalizable to other settings utilizing similar care models and health equity endeavors. Such case studies are critical to advance our understanding and application of innovative implementation science methods such as Implementation Mapping.
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Affiliation(s)
- Kelsey S. Dickson
- Department of Child and Family Development, San Diego State University, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- *Correspondence: Kelsey S. Dickson
| | - Tana Holt
- Department of Child and Family Development, San Diego State University, San Diego, CA, United States
- San Diego State University Research Foundation, San Diego State University, San Diego, CA, United States
| | - Elva Arredondo
- Department of Psychology, San Diego State University, San Diego, CA, United States
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, United States
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SmithBattle L, Loman DG, Yoo JH, Cibulka N, Rariden C. Evidence for Revising the Adverse Childhood Experiences Screening Tool: a Scoping Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:89-103. [PMID: 35222777 PMCID: PMC8837767 DOI: 10.1007/s40653-021-00358-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 05/15/2023]
Abstract
The relationship between adverse childhood experiences (ACEs) and risky behavior, chronic illness, and premature mortality is well documented. Despite this evidence, screening for ACEs in primary care settings remains limited. Objections to widespread screening include concerns that the original ACE screening tool limited childhood adversities to family and household dysfunction. The purpose of this scoping review is to describe current knowledge for expanding ACEs categories and revising the formatting and scoring of the screening tool. With the assistance of a medical librarian, we used a two-step process to conduct a systematic search in three databases (CINAHL, OVID Medline, PsycINFO). Our aim was to focus on articles that expanded ACE categories and/or revised the scoring or formatting of the ACE tool. Eighteen articles (reporting 19 studies) met criteria. A minimum of two authors extracted the relevant characteristics of the studies independently and conferred to reach agreement. The majority of studies broadened ACEs to include community and systemic categories; three studies revised the formatting or scoring of the ACE tool. Exposure to community violence (ECV) was the most frequently added category (15), followed by economic hardship in childhood (EHC) (13); bullying (10); absence/death of parent or significant others (9); and discrimination (7). This evidence supports the expansion of ACE screening tools for assessment of childhood trauma and timely treatment.
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Affiliation(s)
- Lee SmithBattle
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104 USA
| | - Deborah G. Loman
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104 USA
| | - Jee Hye Yoo
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104 USA
| | - Nancy Cibulka
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104 USA
| | - Christina Rariden
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104 USA
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Mendizabal A, Nathan CL, Khankhanian P, Anto M, Clyburn C, Acaba-Berrocal A, Breen L, Dahodwala N. Adverse Childhood Experiences in Patients With Neurologic Disease. Neurol Clin Pract 2022; 12:60-67. [PMID: 36157623 PMCID: PMC9491504 DOI: 10.1212/cpj.0000000000001134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
Background and Objectives To describe the prevalence of high adverse childhood experiences (ACEs) among neurology outpatients and determine their association with health care utilization rates and comorbid medical and psychiatric disease. Methods This was a cross-sectional study of adults seen for outpatient neurology follow-up at the University of Pennsylvania. Participants completed the ACE questionnaire and depression/anxiety screenings. Health care utilization metrics (emergency department [ED] visits, hospitalizations, and outpatient calls) were obtained for all participants. High ACE scores were defined as a score of ≥4. The prevalence of high ACE scores in our cohort was compared with US historical controls. Statistical associations were adjusted for age, sex, and race/ethnicity. Results One hundred ninety-eight patients were enrolled in the study. Neurology patients were more likely to have elevated ACE scores compared with US population estimates (23.7% vs 12.6%, p < 0.01). High ACE scores were associated with increased ED utilization (odds ratio [OR] = 21, 95% CI [5.8-76.0], p < 0.01), hospitalizations (OR = 5.2, 95% CI [1.7-15.0], p < 0.01), and telephone encounters (OR 3, 95% CI [1.1-8.2], p < 0.05). High ACEs were also associated with medical and psychiatric comorbidities (OR 5.8, 95% CI [2.0-17.0], p < 0.01 and OR 4.5, 95% CI [2.1-9.6], p < 0.01) and high depression and anxiety scores (OR = 6.9, 95% CI [2.8-17.0], p < 0.01, and OR = 4.3, [95% CI 1.7-11.0], p < 0.01). Discussion Patients with neurologic conditions are more likely to have high ACEs than the US population, which was associated with higher rates of health care utilization, increased number of medical and psychiatric comorbidities, and higher anxiety and depression scores. Addressing ACEs may be a way to improve the health outcomes of patients with neurologic conditions.
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20
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Aquilina SR, Shrubsole MJ, Butt J, Sanderson M, Schlundt DG, Cook MC, Epplein M. Adverse childhood experiences and adult diet quality. J Nutr Sci 2021; 10:e95. [PMID: 34804516 PMCID: PMC8596075 DOI: 10.1017/jns.2021.85] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022] Open
Abstract
Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40-79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race-sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.
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Affiliation(s)
| | - Martha J. Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Butt
- Infections and Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Mekeila C. Cook
- Division of Public Health Practice, Meharry Medical College, Nashville, TN, USA
| | - Meira Epplein
- Department of Population Health Sciences, Duke University and Cancer Risk, Detection, and Interception Program, Duke Cancer Institute, Durham, NC, USA
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21
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Ports KA, Tang S, Treves-Kagan S, Rostad W. Breaking the cycle of Adverse Childhood Experiences (ACEs): Economic position moderates the relationship between mother and child ACE scores among Black and Hispanic families. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106067. [PMID: 35125581 PMCID: PMC8815463 DOI: 10.1016/j.childyouth.2021.106067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
IMPORTANCE Adverse Childhood Experiences (ACEs) are prevalent, preventable, and a public health issue that cycles from one generation to the next with serious implications for health and wellbeing, particularly. Research is needed to identify factors, including those related to economic position (i.e., wage, net family wealth, home ownership), that break the cycle of ACEs and inform decisions about policies, practices, and programs. OBJECTIVE To determine whether economic position moderates the association between mother's ACE score and child's ACE score and whether these pathways differ by race and ethnicity. DESIGN Conducted regression and moderation analysis using mother-child dyadic data from panel surveys, stratified by race. The simple slopes for the interactions were probed to determine the magnitude and significance of the interaction. SETTING Secondary data analysis utilizing data from two cohorts of the National Longitudinal Surveys: 1) National Longitudinal Survey of Youth 1979; and 2) National Longitudinal Survey of Youth 1979 Children and Young Adults. PARTICIPANTS The sample included 6,261 children and 2,967 matched mothers. MAIN OUTCOMES S AND MEASURES The outcome variable was the child's ACE score. Mother's ACE score was the independent variable. Three economic position moderators were examined: mother's and her spouse's average wage and salary, average net family wealth, and percent of time owning a home during her child's first five years of life. RESULTS Mother's ACE score was positively associated with her child's ACE score. Economic position was a significant moderator for Black families. Higher wages and net family wealth during children's first five years were associated with weakened associations between mother and child ACEs for Black families. For Hispanic families, higher wages and salary were significantly associated with weakened associations. Among White families, higher net family wealth was associated with stronger ACEs transmission. CONCLUSIONS AND RELEVANCE Taken together, these findings highlight the important role that economic position may play on breaking the cycle of ACEs. This information can inform decisions about what public assistance policies, practices, and programs may be used to improve economic stability among families as an effective ACEs prevention strategy, and for whom these strategies might be most effective at reducing the cycle of ACEs.
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Affiliation(s)
- Katie A. Ports
- Corresponding author at: Health Equity Research Applied, Atlanta, GA 30316, United States. , (K.A. Ports)
| | - Shichao Tang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
| | - Sarah Treves-Kagan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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22
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Martinasek MP, Wheldon CW, Parsons CA, Bell LA, Lipski BK. Understanding Adverse Childhood Experiences as Predictors of Cigarette and E-Cigarette Use. Am J Prev Med 2021; 60:737-746. [PMID: 33781621 DOI: 10.1016/j.amepre.2021.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Adverse childhood experiences contribute to both short- and long-term health issues and negative health behaviors that affect the individual as well as families and communities. Exposure to ≥4 of the 11 adverse childhood experiences (high adverse childhood experiences) compounds the problems in later life. This study assesses the associations among tobacco use, adverse childhood experiences, mental health, and community health. METHODS This study was a secondary data analysis utilizing a large 2019 data set from a Community Health Needs Assessment in Florida (N=14,056). Investigators utilized inferential statistics to determine adverse childhood experiences as a predictor of tobacco use (vaping and cigarette use). In addition, they examined whether a shorter, 2-question adverse childhood experience scale was equivalent to the full scale when predicting tobacco use. RESULTS The results indicated that parental divorce was the most common household stressor, followed by mental illness and alcoholism. High adverse childhood experiences were found to be most prominent in marginalized individuals. For those individuals experiencing ≥4 adverse childhood experiences, parental divorce continued to rank high, followed by mental illness. Household stressors included emotional and physical abuse as the most prevalent in the ≥4 adverse childhood experience group. High adverse childhood experiences were associated with current cigarette smoking (AOR=1.56) after controlling for individual mental health and social/community health variables. High adverse childhood experiences were also associated with E-cigarette use (AOR=1.81) but not dual cigarette/E-cigarette use. Social and community health was inversely associated with tobacco use. A 2-item adverse childhood experiences measure was sufficient in identifying tobacco users. CONCLUSIONS Including adverse childhood experiences in community needs assessments provides important information for tobacco control efforts and prevention of chronic disease.
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Affiliation(s)
- Mary P Martinasek
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida.
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | | | | | - Briana K Lipski
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida
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Walker CS, Walker BH, Brown DC, Buttross S, Sarver DE. Defining the role of exposure to ACEs in ADHD: Examination in a national sample of US children. CHILD ABUSE & NEGLECT 2021; 112:104884. [PMID: 33360863 DOI: 10.1016/j.chiabu.2020.104884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Clinical presentations of ADHD vary according to biological and environmental developmental influences. An emerging field of research has demonstrated relationships between exposure to adverse childhood experiences (ACEs) and ADHD prevalence, particularly in high-risk samples. However, research examining the combined role of traditional risk factors of ADHD and ACEs is limited, and reliance on high-risk samples introduces sampling bias. OBJECTIVE To examine the influence of ACEs on ADHD diagnosis using a large, nationally representative sample of US children. PARTICIPANTS AND SETTING Nationally representative samples (2017 and 2018) of 40,075 parents from the National Survey of Children's Health (NSCH). METHODS We conducted logistic regression models to examine the association of ACEs and ADHD diagnosis, controlling for child and parent demographic variables and other risk factors. RESULTS Exposure to ACEs was significantly associated with parent-reported ADHD diagnosis, controlling for known parental and child-risk factors of ADHD. The association followed a gradient pattern of increased ADHD prevalence with additional exposures. Compared to children with no ACEs, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration. CONCLUSIONS Results further strengthen the evidence that ACEs exposure is associated with increased ADHD prevalence. Clinicians should assess ACEs in the diagnosis of ADHD. Furthermore, results of the study lend support to the efforts of agencies (both institutional and state-level) promoting routine screening of ACEs in children.
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Affiliation(s)
| | - Benjamin H Walker
- Social Science Research Center, Mississippi State University, United States
| | - Dustin C Brown
- Social Science Research Center, Mississippi State University, United States; Department of Sociology, Mississippi State University, United States
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Menza TW, Lipira L, Bhattarai A, Leon VCD, Orellana ER. Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR. BMC Womens Health 2020; 20:219. [PMID: 33008421 PMCID: PMC7532610 DOI: 10.1186/s12905-020-01088-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/24/2020] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited. METHODS In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex. RESULTS Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P < 0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low. CONCLUSIONS In a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.
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Affiliation(s)
- Timothy W Menza
- HIV/STD/TB Section, Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Portland, Oregon, 97232, USA.
- Oregon Health & Sciences University (OHSU), Portland, Oregon, USA.
- Multnomah County Health Department, Portland, Oregon, USA.
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Specific adverse childhood experiences and their association with other adverse childhood experiences, asthma and emotional, developmental and behavioral problems in childhood. Pediatr Res 2020; 88:100-109. [PMID: 32051534 PMCID: PMC8104128 DOI: 10.1038/s41390-020-0784-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/19/2019] [Accepted: 11/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have lifelong health consequences, yet screening remains challenging. Particularly in clinical settings, brief screeners that could lead to comprehensive assessments may be more feasible. We explore how two ACEs (economic hardship, parental/caregiver divorce/separation) are associated with other ACEs, asthma, and emotional, developmental, or behavioral (EDB) problems. METHODS Using the 2016 National Survey of Children's Health, we assessed the associations between ACEs and asthma and EDB problems and calculated sensitivities, specificities and predictive values. RESULTS Parents frequently reported 1+ ACEs for their child (50.3%). Individual ACE frequency ranged from 4.2 to 29.6%; all were significantly associated with EDB problems (adjusted odds ratios (aORs): 2.2-5.1) and more ACEs confirmed higher odds. Two ACES (economic hardship, parental/caregiver divorce/separation) co-occurred frequently with other ACEs, having either predicted EDB problems similarly to other ACEs (aORs 1.8; 95% CI 1.4, 2.3) and having both greatly increased odds (aOR 3.8; 95% CI 2.8, 5.2). The negative predictive value of EDB problems associated with citing neither ACE was high (95.7%). Similar trends with asthma were observed. CONCLUSIONS Economic hardship and caregiver separation are strongly associated with other ACEs, EDB problems and asthma. A brief screener including these ACEs may reduce clinical barriers to broader ACEs screening.
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Lown EA, Lui CK, Karriker-Jaffe K, Mulia N, Williams E, Ye Y, Li L, Greenfield TK, Kerr WC. Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort. BMC Public Health 2019; 19:1007. [PMID: 31351463 PMCID: PMC6661082 DOI: 10.1186/s12889-019-7337-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. Methods Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. Results T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). Conclusion ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.
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Affiliation(s)
- E Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 3333 California Street, San Francisco, CA, 94118, USA.
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Kate Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA, 94608, USA
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Abstract
Addressing adverse childhood experiences (ACEs) in primary care pediatric practice is riddled with potential pitfalls that prevent most providers from implementing ACE or toxic stress screening in their practices. However, the growing body of literature and clinician experience about ACE screening shows how this practice is also ripe with possibilities beyond just the treatment of trauma-related diagnoses and for the prevention of intergenerational transmission of toxic stress. This article reviews the current state of screening for ACEs and toxic stress in practice, describes how pediatricians and clinics have overcome pitfalls during implementation of practice-based screening initiatives, and discusses possibilities for the future of primary care-based screening. [Pediatr Ann. 2019;48(7):e257-e261.].
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Crouch E, Probst JC, Radcliff E, Bennett KJ, McKinney SH. Prevalence of adverse childhood experiences (ACEs) among US children. CHILD ABUSE & NEGLECT 2019; 92:209-218. [PMID: 31003066 DOI: 10.1016/j.chiabu.2019.04.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs. METHODS Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs. RESULTS The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status. CONCLUSIONS We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.
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Affiliation(s)
- Elizabeth Crouch
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States.
| | - Janice C Probst
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Radcliff
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Kevin J Bennett
- University of South Carolina School of Medicine, Columbia, South Carolina, United States
| | - Selina Hunt McKinney
- University of South Carolina College of Nursing, Columbia, South Carolina, United States
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Sonu S, Post S, Feinglass J. Adverse childhood experiences and the onset of chronic disease in young adulthood. Prev Med 2019; 123:163-170. [PMID: 30904602 DOI: 10.1016/j.ypmed.2019.03.032] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/01/2019] [Accepted: 03/17/2019] [Indexed: 12/31/2022]
Abstract
This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18-34, 35-54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.
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Affiliation(s)
- Stan Sonu
- Division of General Medicine & Geriatrics, Division of General Pediatrics & Adolescent Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA, United States of America.
| | - Sharon Post
- Health and Medicine Policy Research Group, Chicago, IL, United States of America
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Grey HR, Ford K, Bellis MA, Lowey H, Wood S. Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel. CHILD ABUSE & NEGLECT 2019; 90:22-31. [PMID: 30716652 DOI: 10.1016/j.chiabu.2019.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality. METHODS This study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012-2016) of cases from a CDOP in North West England were examined. RESULTS Of 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72-86.59) times more likely (than those with 0 ACEs) to be classified as 'avoidable and non-natural' causes (e.g., injury, abuse, suicide; compared with 'genetic and medical conditions'). Such children were also 3.44 (1.75-6.73) times more likely to have their deaths classified as 'chronic and acute conditions'. CONCLUSIONS This study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from 'chronic and acute conditions' suggest that ACEs may be important factors in child deaths in addition to those classified as 'avoidable and non-natural'. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.
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Affiliation(s)
- Hannah R Grey
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK; Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
| | - Helen Lowey
- Specialist Public Health Department, Blackburn with Darwen Borough Council, 10 Duke Street, Blackburn, BB2 1DH, UK
| | - Sara Wood
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
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Morrill MI, Schulz MS, Nevarez MD, Preacher KJ, Waldinger RJ. Assessing within- and between-family variations in an expanded measure of childhood adversity. Psychol Assess 2019; 31:660-673. [PMID: 30628820 DOI: 10.1037/pas0000691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous measures of childhood adversity have enabled the identification of powerful links with later-life wellbeing. The challenge for the next generation of childhood adversity assessment is to better characterize those links through comprehensive, fine-grained measurement strategies. The expanded, retrospective measure of childhood adversity presented here leveraged analytic and theoretical advances to examine multiple domains of childhood adversity at both the microlevel of siblings and the macrolevel of families. Despite the fact that childhood adversity most often occurs in the context of families, there is a dearth of studies that have validated childhood adversity measures on multiple members of the same families. Multilevel psychometric analyses of this childhood adversity measure administered to 1,194 siblings in 500 families indicated that the additional categories of childhood adversity were widely endorsed, and increased understanding of the sources and sequalae of childhood adversity when partitioned into within- and between-family levels. For example, multilevel confirmatory factor analyses (MCFAs) indicated that financial stress, unsafe neighborhood, and parental unemployment were often experienced similarly by siblings in the same families and stemmed primarily from family wide (between-family) sources. On the other hand, being bullied and school stressors were often experienced differently by siblings and derived primarily from individual (within-family) processes. Multilevel structural equation modeling (MSEM) further illuminated differential criterion validity correlations between these categories of childhood adversity with midlife psychological, social, and physical health. Expanded, multidomain, and multilevel measures of childhood adversity appear to hold promise for identifying layered causes and consequences of adverse childhood experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Review of Tools for Measuring Exposure to Adversity in Children and Adolescents. J Pediatr Health Care 2018; 32:564-583. [PMID: 30369409 DOI: 10.1016/j.pedhc.2018.04.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022]
Abstract
Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools.
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Shah AN, Beck AF, Sucharew HJ, Litman S, Pfefferman C, Haney J, Shah SS, Simmons JM, Auger KA. Parental Adverse Childhood Experiences and Resilience on Coping After Discharge. Pediatrics 2018; 141:peds.2017-2127. [PMID: 29563237 PMCID: PMC5869339 DOI: 10.1542/peds.2017-2127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adults with a history of adverse childhood experiences (ACEs) (eg, abuse) have suboptimal health outcomes. Resilience may blunt this effect. The effect of parental ACEs (and resilience) on coping with challenges involving their children (eg, hospitalization) is unclear. We sought to quantify ACE and resilience scores for parents of hospitalized children and evaluate their associations to parental coping after discharge. METHODS We conducted a prospective cohort study at a children's hospital (August 2015-May 2016). Eligible participants were English-speaking parents of children hospitalized on the Hospital Medicine or Complex Services team. The ACE questionnaire measured the responding parent's past adversity (ACE range: 0-10; ≥4 ACEs = high adversity). The Brief Resilience Scale (BRS) was used to measure their resilience (range: 1-5; higher is better). The primary outcome was measured by using the Post-Discharge Coping Difficulty Scale via a phone call 14 days post-discharge (range: 0-100; higher is worse). Associations were assessed by using multivariable linear regression, adjusting for parent- and patient-level covariates. RESULTS A total of 671 (81% of eligible parents) responded. Respondents were primarily women (90%), employed (66%), and had at least a high school degree (65%); 60% of children were white, 54% were publicly insured. Sixty-four percent of parents reported ≥1 ACE; 19% had ≥4 ACEs. The mean Brief Resilience Scale score for parents was 3.95. In adjusted analyses, higher ACEs and lower resilience were significantly associated with more difficulty coping after discharge. CONCLUSIONS More parental adversity and less resilience are associated with parental coping difficulties after discharge, representing potentially important levers for transition-focused interventions.
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Affiliation(s)
- Anita N. Shah
- Divisions of Hospital Medicine,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Andrew F. Beck
- Divisions of Hospital Medicine,,General and Community Pediatrics,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Heidi J. Sucharew
- Biostatistics and Epidemiology,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | | | - Cory Pfefferman
- Divisions of Hospital Medicine,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Julianne Haney
- College of Arts and Sciences, University of Dayton, Dayton, Ohio
| | - Samir S. Shah
- Divisions of Hospital Medicine,,Infectious Diseases and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Jeffrey M. Simmons
- Divisions of Hospital Medicine,,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Katherine A. Auger
- Divisions of Hospital Medicine,,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
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Leonard SA, Petito LC, Rehkopf DH, Ritchie LD, Abrams B. Maternal History of Child Abuse and Obesity Risk in Offspring: Mediation by Weight in Pregnancy. Child Obes 2017; 13:259-266. [PMID: 28440693 PMCID: PMC5549809 DOI: 10.1089/chi.2017.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Women's experience of childhood adversity may contribute to their children's risk of obesity. Possible causal pathways include higher maternal weight and gestational weight gain, which have been associated with both maternal childhood adversity and obesity in offspring. METHODS This study included 6718 mother-child pairs from the National Longitudinal Survey of Youth 1979 in the United States (1979-2012). We applied multiple log-binomial regression models to estimate associations between three markers of childhood adversity (physical abuse, household alcoholism, and household mental illness) and offspring obesity in childhood. We estimated natural direct effects to evaluate mediation by prepregnancy BMI and gestational weight gain. RESULTS Among every 100 mothers who reported physical abuse in childhood, there were 3.7 (95% confidence interval: -0.1 to 7.5) excess cases of obesity in 2- to 5-year olds compared with mothers who did not report physical abuse. Differences in prepregnancy BMI, but not gestational weight gain, accounted for 25.7% of these excess cases. There was no evidence of a similar relationship for household alcoholism or mental illness or for obesity in older children. CONCLUSIONS In this national, prospective cohort study, prepregnancy BMI partially explained an association between maternal physical abuse in childhood and obesity in preschool-age children. These findings underscore the importance of life-course exposures in the etiology of child obesity and the potential multi-generational consequences of child abuse. Research is needed to determine whether screening for childhood abuse and treatment of its sequelae could strengthen efforts to prevent obesity in mothers and their children.
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Affiliation(s)
| | - Lucia C. Petito
- Division of Biostatistics, University of California, Berkeley, CA
| | - David H. Rehkopf
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
| | - Lorrene D. Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Berkeley, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California, Berkeley, CA
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Vargas ED, Sanchez GR, Juárez M. The Impact of Punitive Immigrant Laws on the Health of Latina/o Populations. POLITICS & POLICY (STATESBORO, GA.) 2017; 45:312-337. [PMID: 29200985 PMCID: PMC5703223 DOI: 10.1111/polp.12203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study examines how anti-immigrant policies affect the physical health of Latina/os in the United States. Merging two unique datasets: sum of anti-immigrant policies by state from 2005-2011 and a 2011 Robert Wood Johnson Center for Health Policy nationally representative sample of Latina/os (n=1,200), we estimate a series of logistic regressions to understand how anti-immigrant legislations are affecting the health of Latina/os. Our modeling approach takes into consideration Latinos' diverse experience, context that is widely overlooked in datasets that treat Latina/os as a homogeneous ethnic group. Our findings suggest that an increase in anti-immigrant laws enacted by a state decreases the probability of respondents reporting optimal health, even when controlling for other relevant factors, such as citizenship status, language of interview, and interethnic variation. The implication and significance of this work has tremendous impacts for scholars, policy makers, health service providers and applied researchers interested in reducing health disparities among minority populations.
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