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Baker NS, VanHook C, Ziminski D, Semenza D, Lassiter T, Garmon J, Bonne S. What's missing? Violently injured Black men's narratives around Adverse Childhood Experiences (ACEs). CHILD ABUSE & NEGLECT 2024; 149:106644. [PMID: 38237241 DOI: 10.1016/j.chiabu.2024.106644] [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: 08/22/2023] [Revised: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Adverse childhood experiences have been associated with future outcomes; however, Felitti's 1998 ACEs questionnaire fails to capture the experiences of Black populations living in disinvested neighborhoods making it necessary to expand the ACEs questionnaire to examine the life experiences of violently injured Black men. OBJECTIVE The aim of the study was to advance the understanding of ACEs among Black male firearm violence survivors using the ACEs questionnaire and semi-structured interviews. PARTICIPANTS AND SETTING Ten Black male firearm violence survivors were recruited from an urban HVIP. Case managers conducted recruitment using the HVIP's REDcap database; active and previous HVIP participants were eligible for the study. METHODS A qualitative study design was used to understand the childhood experiences of Black male firearm violence survivors using Felitti's ACEs questionnaire and a semi-structured interview examining perceptions of their childhood experiences. Due to the COVID-19 pandemic, recruitment and interviews were conducted over the phone. RESULTS All participants experienced at least one ACE. Three themes arose from the interviews: youth incarceration, family separation and loss, and housing transition. Men at risk for violent injury experience ACEs beyond those measured in the current instrument.
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Affiliation(s)
- Nazsa S Baker
- New Jersey Gun Violence Research Center, 683 Hoes Ln W, Piscataway, NJ 08854, United States.
| | - Cortney VanHook
- University of Illinois- Urbana-Champaign, School of Social Work, 1010 W Nevada St, Urbana, IL 61801, United States
| | - Devon Ziminski
- Rutgers University-New Brunswick, School of Social Work, 120 Albany St, New Brunswick, NJ 08901, United States
| | - Daniel Semenza
- New Jersey Gun Violence Research Center, 683 Hoes Ln W, Piscataway, NJ 08854, United States; Rutgers University-Camden, Department of Sociology, Anthropology, and Criminal Justice, 405-7 Cooper Street, Camden, NJ 08102, United States
| | - Teri Lassiter
- Rutgers University-Newark, School of Public Health, 1 Riverfront Plaza, Newark, NJ 07102, United States
| | - Jeannie Garmon
- Rutgers University-Camden, 303 Cooper St, Camden, NJ 08102, United States
| | - Stephanie Bonne
- Hackensack University Medical Center, Department of Surgery, 30 Prospect Ave, Hackensack, NJ 07601, United States
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Anyigbo C, Todd E, Tumin D, Kusma J. Health Insurance Coverage Gaps Among Children With a History of Adversity. Med Care Res Rev 2023; 80:648-658. [PMID: 37329285 DOI: 10.1177/10775587231180673] [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] [Indexed: 06/19/2023]
Abstract
Health insurance stability among children with adverse childhood experiences (ACEs) is essential for accessing health care services. This cross-sectional study used an extensive, multi-year, nationally representative database of children aged 0 to 17 to examine the association between ACE scores and continuous or intermittent lack of health insurance over a 12-month period. Secondary outcomes were reported reasons for coverage gaps. Compared with children having 0 ACEs, those with 4+ ACEs had a higher likelihood of being part-year uninsured rather than year-round private insured (relative risk ratio [RRR]: 4.20; 95% CI: 3.25, 5.43), year-round public insured (RRR: 1.37; 95% CI: 1.06, 1.76), or year-round uninsured (RRR: 2.28; 95% confidence interval [CI]: 1.63, 3.21). Among children who experienced part-year or year-round uninsurance, a higher ACE score was associated with a greater likelihood of coverage gap due to difficulties with the application or renewal process. Policy changes to reduce administrative burdens may improve health insurance stability and access to health care among children who endure ACEs.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emmalee Todd
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Jennifer Kusma
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago IL, USA
- Mary Ann & J.Milburn Smith Child Health Outcomes, Research and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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3
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Orihuela CA, Cox C, Evans R, Mrug S. Associations of Household Food Insecurity With Academic Outcomes in Early Adolescents. THE JOURNAL OF SCHOOL HEALTH 2023; 93:883-890. [PMID: 37357352 DOI: 10.1111/josh.13358] [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: 06/16/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Food insecurity is characterized by limited access to adequate food due to a lack of money or resources (eg, lack of transportation to obtain food). School aged children who are experiencing food insecurity are at greater risk for poor academic outcomes, but previous studies have not examined the effects of food insecurity on specific academic outcomes over time. METHOD This study examined food insecurity as a risk factor for subsequent academic skills, enablers, and achievement. As part of a larger longitudinal study, middle school students (N = 112; meanage = 12.14, SD = 0.41; 50% female; 68% black/African American, 14% white, 13% Hispanic or Latino, 5% other) reported on food insecurity at baseline, while teachers reported on students' academic skills and enablers at both baseline and 12 months later at 1 year follow up. Math and English/Language Arts grades were obtained from the schools at each wave. FINDINGS Food insecurity predicted lower academic skills over time but was unrelated to academic enablers and grades. IMPLICATIONS Considering a whole school, whole community, whole child (WSCC) framework, this study will also discuss the important role schools and communities have in reducing food insecurity in middle school students. CONCLUSIONS These results support negative long-term effects of food insecurity on academic skills in early adolescents.
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Affiliation(s)
- Catheryn A Orihuela
- University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294
| | - Callista Cox
- University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294
| | - Retta Evans
- University of Alabama at Birmingham, 1150 10th Avenue South, Birmingham, AL, 35294
| | - Sylvie Mrug
- University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294
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4
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Bahanan L, Ayoub S. The association between adverse childhood experiences and oral health: A systematic review. J Public Health Dent 2023. [PMID: 36916213 DOI: 10.1111/jphd.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/19/2022] [Accepted: 02/03/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE It is well established that adverse childhood experiences (ACEs) negatively affect health and are associated with health-risk behaviors. This study aimed to provide a systematic review of the studies that examine the relationship between ACE exposure and oral health among adults aged 18 years and older. METHODS The following electronic databases were searched in January 2022: MEDLINE, Cochrane, Web of Science, CINAHL via EBSCOhost, ProQuest, ScienceDirect, and Google Scholar. Data were extracted independently by two reviewers. The quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS Among the 292 articles identified, four met the eligibility criteria. All included studies were cross-sectional and of satisfactory quality. The dental outcomes included: last dental visit, last dental cleaning, number of filled teeth, number of extracted teeth, and number of remaining teeth. The studies showed that exposure to ACE was negatively associated with oral health. The relationship between ACE score and oral health outcome measures was found to be directly proportional. CONCLUSION There is an association between ACE and poor oral health. Moreover, the association was proven to have a dose-response relationship. Given that the studies in the literature were cross-sectional, causality cannot be determined with certainty, therefore interpretation of the results should be cautious. Longitudinal follow-up studies are needed to understand how ACEs contribute to oral diseases later in life.
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Affiliation(s)
- Lina Bahanan
- Department of Dental Public Health, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Solafa Ayoub
- Department of Dental Public Health, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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5
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Gentry SV, Paterson BA. Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary. J Public Health (Oxf) 2022; 44:810-822. [PMID: 34231848 DOI: 10.1093/pubmed/fdab238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria. METHODS A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC. RESULTS Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. CONCLUSIONS Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.
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Affiliation(s)
- S V Gentry
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK.,Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - B A Paterson
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK
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Alcalá HE, Ng A, Tkach N, Navarra M. Adverse Childhood Experiences and utilization of dental care: A cross sectional study of children in the United States. PEDIATRIC DENTAL JOURNAL 2022. [DOI: 10.1016/j.pdj.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Anyigbo C, Jimenez ME, Sosnowski DW. Association Between Adverse Childhood Experiences at Age 5 Years and Healthcare Utilization at Age 9 Years. J Pediatr 2022; 246:227-234.e2. [PMID: 35427692 DOI: 10.1016/j.jpeds.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years. STUDY DESIGN We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates. RESULTS Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs. CONCLUSION Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH.
| | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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8
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Design of a clinical trial to isolate the experience of food insecurity and elucidate the biological mechanisms of risk for childhood health outcomes. Contemp Clin Trials 2022; 117:106751. [DOI: 10.1016/j.cct.2022.106751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
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9
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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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10
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Goddard A, Janicek E, Etcher L. Trauma-informed care for the pediatric nurse. J Pediatr Nurs 2022; 62:1-9. [PMID: 34798581 PMCID: PMC9757999 DOI: 10.1016/j.pedn.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is not limited to medical trauma and includes chronic stressors, toxic stress, adverse childhood events, abuse, and now the COVID-19 pandemic. Principles of trauma-informed care and resiliency guide pediatric nursing care across the life span from birth to adolescence. Trauma-informed care principles are pertinent to the nursing care needs of healthy and ill children from infancy to adolescence across care settings. METHODS The purpose of this integrative literature review (IRL) is to elucidate evidence-based practices for pediatric nurses specific to trauma, trauma-informed principles, and the integration of these principles to care. Using Whittemore and Knafl's (2005) methodology, this IRL presents empirical literature to operationalize trauma-informed care for the pediatric nurse through 1) identification of the problem; 2) literature search; 3) data evaluation; 4) data analysis; 5) result presentation. FINDINGS Results are presented in a contemporary framework by the Substance Abuse and Mental Health Services Administration (2018) of trauma-awareness for the pediatric nurse, trauma-informed principles, and the integration of these principles to care. Pediatric nurses are in a unique position to offer trauma-informed care by recognizing and managing trauma to include chronic stressors, toxic stress, adverse childhood experiences, and abuse. DISCUSSION Pediatric nurses today are caring for patients in a complex and diverse healthcare climate amid the world's worst public health pandemic in living memory. Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.
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Affiliation(s)
- Anna Goddard
- Quality, Research, & Evaluation, School-Based Health Alliance, United States of America; Sacred Heart University, Davis & Henley College of Nursing, United States of America; Child and Family Agency of Southeastern Connecticut, United States of America.
| | - Erin Janicek
- Child and Family Agency of Southeastern Connecticut, United States of America.
| | - LuAnn Etcher
- Sacred Heart University, Davis & Henley College of Nursing, United States of America.
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11
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Barnes AJ, Gower AL, Sajady M, Lingras KA. Health and adverse childhood experiences among homeless youth. BMC Pediatr 2021; 21:164. [PMID: 33827511 PMCID: PMC8025366 DOI: 10.1186/s12887-021-02620-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health. METHODS Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates. RESULTS The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status. CONCLUSIONS ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.
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Affiliation(s)
- Andrew J Barnes
- Developmental-Behavioral Pediatrics, Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Amy L Gower
- Department of Pediatrics, University of Minnesota Medical School, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Mollika Sajady
- Children's Minnesota Developmental Pediatrics, 2530 Chicago Ave S STE G055, Minneapolis, MN, 55404, USA
| | - Katherine A Lingras
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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12
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Ong JE, Fassel M, Scieszinski L, Hosseini S, Galet C, Oral R, Wibbenmeyer L. The burden of adverse childhood experiences in children and those of their parents in a burn population. J Burn Care Res 2021; 42:944-952. [PMID: 33484246 DOI: 10.1093/jbcr/irab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the prevalence, type, and associations of parental and child adverse childhood experiences (ACEs) in children presenting with burn injuries. METHODS Parents of burned children completed an ACE-18 survey, including questions on parent and child ACEs, needs, and resiliency. Demographics, burn injury, hospital course, and follow up data were collected. Family needs and burn outcomes of children with and without ACEs' exposure (NO ACE vs. 1-2 ACE vs ≥ 3 ACE) was analyzed. P < 0.05 was considered significant. RESULTS Seventy-five children were enrolled; 58.7% were male, 69.3% white. The average age was 6.0 ± 5.2 years. The average total burn surface area was 4.4 ± 5.7% (0.1 to 27%). Parent ACE exposure correlated with child ACE exposure (r = 0.57; p = 0.001) and this intensified by increasing child age (p = 0.004). Child ACE exposure showed a graded response to family needs, including food and housing insecurity and childcare needs. Stress and psychosocial distress of the parents was significantly associated with their children's ACE burden. CONCLUSIONS The ACE burden of parents of burned children can affect the ACE load of their children. Burned children with more ACEs tend to have significantly more needs and more family distress. Awareness of past trauma can help identify a vulnerable population to ensure successful burn recovery.
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Affiliation(s)
- Jia Ern Ong
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA
| | - Mikenzy Fassel
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | | | - Colette Galet
- Department of Surgery, University of Iowa, Iowa City, IA
| | - Resmiye Oral
- Dartmouth Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH
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13
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Davenport TE, DeVoght AC, Sisneros H, Bezruchka S. Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy. Phys Ther 2020; 100:995-1007. [PMID: 32115638 DOI: 10.1093/ptj/pzaa031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/24/2019] [Indexed: 02/09/2023]
Abstract
The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapist practice, and the profession's role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association's vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts could provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as providing actionable suggestions for physical therapists to help develop and implement upstream interventions that could reduce the impact of OUD in their communities.
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Affiliation(s)
- Todd E Davenport
- Department of Physical Therapy, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, 3601 Pacific Avenue, Stockton, CA 95211 USA
| | | | | | - Stephen Bezruchka
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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14
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Hickey E, Phan M, Beck AF, Burkhardt MC, Klein MD. A Mixed-Methods Evaluation of a Novel Food Pantry in a Pediatric Primary Care Center. Clin Pediatr (Phila) 2020; 59:278-284. [PMID: 31970997 DOI: 10.1177/0009922819900960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Evidence suggests that management of food insecurity in primary care may enhance preventive care delivery. This study assessed the impact of a food pantry in a pediatric primary care center over 22 months. Quantitative outcome assessments (number of children affected, number of referrals, and completion of preventative services) compared the child receiving food from the pantry to age-matched controls. Commonalities from interviews with pantry-using families were identified using thematic analysis. A total of 504 index patients received food from the pantry during an office visit. There were 546 in-clinic and community referrals. There was no significant relationship between accessing the pantry and preventative service completion by 27 months of age. Themes that emerged during interviews included the need for an emergency food source, facilitation of referrals, and increased trust in the clinic. An in-clinic food pantry is a feasible and family-welcomed approach to address food insecurity in pediatric primary care.
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Affiliation(s)
- Erin Hickey
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle Phan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | | | - Melissa D Klein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
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15
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Dush JL. Adolescent food insecurity: A review of contextual and behavioral factors. Public Health Nurs 2020; 37:327-338. [PMID: 31970826 PMCID: PMC9292303 DOI: 10.1111/phn.12708] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/03/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes. DESIGN A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase® , Pubmed, and the Cochrane Library. SAMPLE The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity. RESULTS Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized. CONCLUSION Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.
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Affiliation(s)
- Jennifer L Dush
- Instructor of Clinical Practice, The Ohio State University, Columbus, OH, USA
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Popp TK, Geisthardt C, Bumpus EA. Pediatric Practitioners' Screening for Adverse Childhood Experiences: Current Practices and Future Directions. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:1-10. [PMID: 31910795 DOI: 10.1080/19371918.2020.1711839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This pilot study surveyed pediatric medical practitioners on their screening of Adverse Childhood Experiences (ACEs). The study focused on perspectives related to engagement in screening and barriers to screening. Practitioners were pediatric and family physicians and physician assistants (N = 48). Results suggest that although practitioners believed it was their role to screen, less than half did so. They were more likely to screen if they were familiar with the research on ACEs, or had received training on ACEs screening. Perceived barriers included lack of professional education on the topic, not enough time to screen, and lack of appropriate screening tools. Other issues such as which ACEs were most likely to be screened for and follow-up practices after positive screening also were explored. Further work is needed to understand screening and treatment practices, and policy changes should be explored in an attempt to increase practitioner involvement in ACEs screening.
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Affiliation(s)
- Tierney K Popp
- Department of Human Development and Family Studies, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Cheryl Geisthardt
- Department of Human Development and Family Studies, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Elizabeth A Bumpus
- Department of Human Development and Family Studies, Western Michigan University, Kalamazoo, Michigan, USA
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Eismann EA, Folger AT, Stephenson NB, Brownrigg ME, Shapiro RA, Macaluso M, Gillespie RJ. Parental Adverse Childhood Experiences and Pediatric Healthcare Use by 2 Years of Age. J Pediatr 2019; 211:146-151. [PMID: 31079855 DOI: 10.1016/j.jpeds.2019.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/05/2019] [Accepted: 04/10/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether maternal and paternal exposure to adverse childhood experiences (ACEs) has an association with offspring healthcare use by 2 years of age. STUDY DESIGN A retrospective cohort study was performed on 454 patients at a large suburban pediatric primary care practice whose mother (n = 374) or father (n = 156) or both (n = 123) completed an ACE survey between October 2012 and June 2014. The association between self-reported parental ACEs and healthcare use by 2 years of age, including number of missed well-child visits, sick visits, and delayed or missed immunizations, was modeled using multivariable negative binomial regression. All analyses adjusted for child sex, payer source, and preterm birth. RESULTS Maternal, but not paternal, ACE exposure was significantly associated with missed well-child visits by 2 years of age. For each additional maternal ACE, there was a significant 12% increase in the incidence rate of missed well-child visits (relative risk, 1.12; 95% CI, 1.03-1.22; P = .010). Maternal and paternal ACE scores were not significantly associated with increased sick visits or delayed or missed immunizations. CONCLUSIONS The ACE exposure of mothers is negatively associated with adherence to preventive healthcare visits among their children early in life. Future research is needed to elucidate the mechanisms of this association and to develop and implement family-based intervention strategies.
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Affiliation(s)
- Emily A Eismann
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alonzo T Folger
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nicole B Stephenson
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maggie E Brownrigg
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert A Shapiro
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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McKelvey LM, Saccente JE, Swindle TM. Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health Outcomes in Middle Childhood. Child Obes 2019; 15:206-215. [PMID: 30762431 PMCID: PMC7001385 DOI: 10.1089/chi.2018.0225] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood. METHODS We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health. RESULTS Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs. CONCLUSIONS Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.
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Affiliation(s)
- Lorraine M. McKelvey
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jennifer E. Saccente
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Taren M. Swindle
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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