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Golden CV, Assaf RR, Aguilar R, Moreno T, Huszti H, Fortier M, Heyming T, Rao U, Ehwerhemuepha L, Weiss M. Age, Adverse Childhood Experiences, and Health Care Utilization. Pediatrics 2024:e2023064838. [PMID: 39420864 DOI: 10.1542/peds.2023-064838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVES To assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age. METHODS In this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening. RESULTS Among 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age. CONCLUSIONS The association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.
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Affiliation(s)
| | - Raymen R Assaf
- Children's Hospital of Orange County, Orange, California
- School of Medicine, University of California, Irvine, California
| | | | - Tatiana Moreno
- Children's Hospital of Orange County, Orange, California
| | - Heather Huszti
- Children's Hospital of Orange County, Orange, California
| | - Michelle Fortier
- Children's Hospital of Orange County, Orange, California
- Sue and Bill Gross School of Nursing, University of California, Irvine, California
| | | | - Uma Rao
- Children's Hospital of Orange County, Orange, California
- School of Medicine, University of California, Irvine, California
| | | | - Michael Weiss
- Children's Hospital of Orange County, Orange, California
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Graham AL, Cha S, Jacobs MA, Amato MS, Funsten AL, Edwards G, Papandonatos GD. A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users: A Randomized Clinical Trial. JAMA 2024; 332:713-721. [PMID: 39110436 PMCID: PMC11307165 DOI: 10.1001/jama.2024.11057] [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: 01/21/2024] [Accepted: 05/22/2024] [Indexed: 08/10/2024]
Abstract
Importance E-cigarettes are the most commonly used tobacco product among adolescents. Despite known harms of nicotine exposure among teens, there are no empirically tested vaping cessation interventions. Objective To compare the effectiveness of a text message program for nicotine vaping cessation among adolescents with assessment-only control. Design, Setting, and Participants A parallel, 2-group, double-blind, individually randomized clinical trial with follow-ups at 1 and 7 months after randomization was conducted from October 1, 2021, to October 18, 2023. Participants were recruited via social media ads; the intervention was delivered via text message; and assessments were completed online or by telephone. Eligible individuals were US residents aged 13 to 17 years who reported past 30-day e-cigarette use, were interested in quitting within 30 days, and owned a mobile phone with an active text message plan. To optimize study retention, all participants received monthly assessments via text message about e-cigarette use. Interventions Assessment-only controls (n = 744) received only study retention text messages. Intervention participants (n = 759) also received an automated, interactive text message program for vaping cessation that delivers cognitive and behavioral coping skills training and social support. Main Outcomes and Measures The primary outcome was self-reported 30-day point-prevalence abstinence from vaping at 7 months analyzed as intention-to-treat, with missingness coded as vaping. Results Among n = 1503 adolescents randomized, average age was 16.4 (SD, 0.8) years. The sample was 50.6% female, 42.1% male, and 7.4% nonbinary/other; 10.2% Black/African American, 62.6% White, 18.5% multiracial, and 8.7% another race; 16.2% Hispanic; 42.5% sexual minority; and 76.2% vaped within 30 minutes of waking. The 7-month follow-up rate was 70.8%. Point-prevalence abstinence rates were 37.8% (95% CI, 34.4%-41.3%) among intervention participants and 28.0% (95% CI, 24.9%-31.3%) among control participants (relative risk, 1.35 [95% CI, 1.17-1.57]; P < .001). No baseline variables moderated the treatment-outcome relationship. There was no evidence that adolescents who quit vaping transitioned to combustible tobacco products. Conclusions and Relevance A tailored, interactive text message intervention increased self-reported vaping cessation rates among adolescents recruited via social media channels. Trial Registration ClinicalTrials.gov Identifier: NCT04919590.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth Initiative, Washington, DC
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC
| | | | - Michael S. Amato
- Innovations Center, Truth Initiative, Washington, DC
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Dumke KA, Hamity C, Peters K, DiGangi M, Negriff S, Sterling SA, Young-Wolff KC. Pediatric ACEs Screening and Referral: Facilitators, Barriers, and Opportunities for Improvement. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:877-886. [PMID: 39309345 PMCID: PMC11413254 DOI: 10.1007/s40653-024-00632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 09/25/2024]
Abstract
Despite well-documented associations between adverse childhood experiences (ACEs) and lifelong impairments in health and well-being, few studies have examined how to facilitate implementation of ACEs screening and referral programs in pediatric settings. We sought to identify facilitators and barriers related to screening for and addressing ACEs in a large integrated healthcare delivery system in Southern California. Using a developmental evaluation approach, we conducted twenty semi-structured interviews with pediatricians, nurses, social workers, and community referral organization staff. Interviews took place across six pediatric clinic pilot sites in Kaiser Permanente Southern California, where more than 7,000 pediatric patients were screened for ACEs between July 2018 and December 2019. Thematic analysis was conducted to identify themes. Key facilitators for screening and referrals for pediatric ACEs screening included providing clinician education to normalize conversations about ACEs, using screening data to provide more holistic and compassionate care, and collaborating across different types of clinicians. Key barriers included screening tool challenges related to patient confusion and cultural differences, capacity limitations, training issues, and care team silos. When used in the context of a trauma- and resilience-informed workforce, ACEs screening may be a powerful tool to support more collaborative and impactful care decisions that move away from symptom management to address root causes and promote prevention.
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Affiliation(s)
- Kelly A. Dumke
- Center for Healthy Living, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Courtnee Hamity
- Care Management Institute, Kaiser Permanente, Oakland, CA USA
| | - Karen Peters
- School of Public Health, University of Illinois Chicago, Chicago, IL USA
| | - Mercie DiGangi
- Downey Medical Center, Kaiser Permanente Southern California, Downey, USA
| | - Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
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Burton ET, Moore JM, Vidmar AP, Chaves E, Cason-Wilkerson R, Novick MB, Fernandez C, Tucker JM. Assessment of Adverse Childhood Experiences and Social Determinants of Health: A Survey of Practices in Pediatric Weight Management Programs. Child Obes 2024; 20:425-433. [PMID: 38133550 DOI: 10.1089/chi.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Introduction: Adverse childhood experiences (ACEs) and social determinants of health (SDoH) are associated with increased incidence of pediatric obesity. Recent literature highlights an imperative need to assess ACEs and SDoH among youth and families with obesity to identify those individuals requiring targeted interventions. The primary objective of the present study was to examine the frequency, methodology, and barriers in evaluation of ACEs and SDoH within pediatric weight management programs (PWMPs). Methods: Invitations were e-mailed to a comprehensive directory of 92 PWMPs in the United States with a link to complete an electronic survey. Results: Forty-one PWMPs from 26 states completed the survey. Assessment of one or more ACEs and SDoH was common and typically took place during the initial patient visit by the psychologist or medical practitioner through unstructured conversations. Reported barriers to assessment included lack of time to assess and to follow-up, lack of clinic protocols, and inadequate referral resources. Programs offering bariatric surgery and those with embedded mental health clinicians reported fewer barriers to ACEs/SDoH referral resources, while family-based and healthy lifestyle-focused programs perceived more barriers related to insufficient support staff and time to follow-up with families. Conclusions: Most PWMPs assess a subset of ACEs and SDoH; however, approaches to assessment vary, are often unstructured, and several barriers remain to optimizing assessment and follow-up. Future research should evaluate standardized ACEs/SDoH assessment protocols, ideal workflow, and their impact on obesity treatment and related health outcomes.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaime M Moore
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alaina P Vidmar
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Eileen Chaves
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rochelle Cason-Wilkerson
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marsha B Novick
- Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Cristina Fernandez
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jared M Tucker
- Health Optimization Services, Helen Devos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
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5
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Heffernan S, O'Malley M, Curtin M, Hawkins A, Murphy R, Goodwin J, Barry K, Taylor A, Happell B, O' Donovan Á. An evaluation of a trauma-informed educational intervention to enhance therapeutic engagement and reduce coercive practices in a child and adolescent inpatient mental health unit. Int J Ment Health Nurs 2024; 33:978-991. [PMID: 38291645 DOI: 10.1111/inm.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
High-risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re-traumatisation of young people and deteriorating therapeutic relationships. Trauma-informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma-informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma-informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma-informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma-informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma-informed practice is crucial to recovery-focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people.
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Affiliation(s)
- Sinéad Heffernan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Maria O'Malley
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Margaret Curtin
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Andrew Hawkins
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Rachel Murphy
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Karen Barry
- Eist Linn, Child and Adolescent Mental Health Services, Cork and Kerry Healthcare, Health Service Executive, Cork, Ireland
| | - Alice Taylor
- Eist Linn, Child and Adolescent Mental Health Services, Cork and Kerry Healthcare, Health Service Executive, Cork, Ireland
| | - Brenda Happell
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Áine O' Donovan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
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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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Choi KR, Bravo L, La Charite J, Cardona E, Elliott T, James KF, Wisk LE, Dunn EC, Saadi A. Associations between Positive Childhood Experiences (PCEs), Discrimination, and Internalizing/Externalizing in Pre-Adolescents. Acad Pediatr 2024:S1876-2859(24)00275-4. [PMID: 39004299 DOI: 10.1016/j.acap.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth. METHODS This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0-5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs. RESULTS Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR=1.47, 95% CI=1.2-1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR=0.82, 95% CI=0.72-0.93). CONCLUSIONS Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.
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Affiliation(s)
- Kristen R Choi
- School of Nursing (KR Choi and E Cardona), UCLA, Los Angeles, Calif; Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif.
| | - Lilian Bravo
- National Clinician Scholars Program (L Bravo and T Elliott), Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | - Jaime La Charite
- Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif
| | | | - Thomas Elliott
- National Clinician Scholars Program (L Bravo and T Elliott), Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | | | - Lauren E Wisk
- Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif; Division of General Internal Medicine & Health Services Research (LE Wisk), Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit (EC Dunn), Center for Genomic Medicine, Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (EC Dunn), Harvard Medical School, Boston, Mass
| | - Altaf Saadi
- Harvard Medical School (A Saadi), Boston, Mass; Department of Neurology (A Saadi), Massachusetts General Hospital, Boston, Mass
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de la Rosa R, Le A, Holm S, Ye M, Bush NR, Hessler D, Koita K, Bucci M, Long D, Thakur N. Associations Between Early-Life Adversity, Ambient Air Pollution, and Telomere Length in Children. Psychosom Med 2024; 86:422-430. [PMID: 38588482 PMCID: PMC11142884 DOI: 10.1097/psy.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Examine the independent associations and interaction between early-life adversity and residential ambient air pollution exposure on relative buccal telomere length (rBTL). METHODS Experiences of abuse, neglect, household challenges, and related life events were identified in a cross-sectional sample of children aged 1 to 11 years ( n = 197) using the 17-item Pediatric ACEs and Related Life Event Screener (PEARLS) tool. The PEARLS tool was analyzed both as a total score and across established domains (Maltreatment, Household Challenges, and Social Context). Ground-level fine particulate matter (PM 2.5 ) concentrations were matched to residential locations for the 1 and 12 months before biospecimen collection. We used multivariable linear regression models to examine for independent associations between continuous PM 2.5 exposure and PEARLS score/domains with rBTL. In addition, effect modification by PEARLS scores and domains on associations between PM 2.5 exposure and rBTL was examined. RESULTS Study participants were 47% girls, with mean (standard deviation) age of 5.9 (3.4) years, median reported PEARLS score of 2 (interquartile range [IQR], 4), median 12-month prior PM 2.5 concentrations of 11.8 μg/m 3 (IQR, 2.7 μg/m 3 ), median 1-month prior PM 2.5 concentrations of 10.9 μg/m 3 (IQR, 5.8 μg/m 3 ), and rBTL of 0.1 (IQR, 0.03). Mean 12-month prior PM 2.5 exposure was inversely associated with rBTL ( β = -0.02, 95% confidence interval = -0.04 to -0.01). Although reported PEARLS scores and domains were not independently associated with rBTL, we observed a greater decrement in rBTL with increment of average annual PM 2.5 as reported Social Context domain items increased ( p -interaction < .05). CONCLUSIONS Our results suggest that adverse Social Context factors may accelerate the association between chronic PM 2.5 exposure on telomere shortening during childhood.
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Affiliation(s)
- Rosemarie de la Rosa
- Environmental Health Sciences Division, University of California, Berkeley, School of Public Health
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Austin Le
- Environmental Health Sciences Division, University of California, Berkeley, School of Public Health
| | - Stephanie Holm
- Western States Pediatric Environmental Health Specialty Unit
| | - Morgan Ye
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Nicole R. Bush
- University of California San Francisco, Department of Psychiatry and Behavioral Science
- University of California, San Francisco, Department of Pediatrics
| | - Danielle Hessler
- University of California San Francisco, Department of Family and Community Medicine
| | | | | | - Dayna Long
- University of California, San Francisco, Department of Pediatrics
- UCSF Benioff Children’s Hospital Oakland
| | - Neeta Thakur
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
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Tang JT, Saadi A, Dunn EC, Choi K. Concordance in Child-Parent Reporting of Social Victimization Experiences in the Adolescent Brain Cognitive Development (ABCD) Study. Acad Pediatr 2024:S1876-2859(24)00055-X. [PMID: 38508874 DOI: 10.1016/j.acap.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate child-parent concordance in reporting social victimization experiences and whether parent concordance with child report of victimization was associated with child behavioral symptoms. METHODS This was an observational study with data from the Adolescent Brain Cognitive Development Social Development (ABCD-SD) substudy. The analytic sample was 2415 pre-adolescent children from the United States. We assessed parent-child concordance on six domains of child social victimization: conventional crime, peer victimization, witnessing violence, internet victimization, school victimization, and gun violence. Child behavior symptoms were measured using the parent-report Child Behavior Checklist. Interrater agreement and multiple linear and logistic regression analyses were conducted to assess parent concordance with child report of victimization and its relationship to behavioral symptoms. RESULTS Interrater agreement in parent-child social victimizations reports was low, with Cohen's Kappa values ranging from 0.10 to 0.23. Compared to parent-child dyads in which neither reported victimization, parent concordance with child report of victimization across multiple domains of social victimization was associated with more internalizing/externalizing behaviors, as was parent discordance with child reports that did not indicate victimization. Among children who reported victimization, parents' perceptions of greater neighborhood safety were associated with lower odds of concordant parent report of conventional crime (OR = 0.94, 95% CI = 0.90-0.98) and witnessing violence (OR = 0.94, 95% CI-0.89-0.98). CONCLUSIONS Parents and children do not necessarily agree in reporting social victimization experiences. Parent reports of child social victimization, whether they were concordant with positive child reports or discordant with negative child reports, were associated with parent reports of behavioral symptoms and thus may be an indicator of the severity of experiences, underscoring the need to consider multiple informants when screening for adversity.
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Affiliation(s)
- Judy T Tang
- Keck Medicine of USC (JT Tang), Los Angeles, Calif
| | - Altaf Saadi
- Department of Neurology (A Saadi), Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Erin C Dunn
- Center for Genomic Medicine (EC Dunn), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (EC Dunn), Harvard Medical School, Boston, Mass; Harvard Center on the Developing Child (EC Dunn), Cambridge, Mass
| | - Kristen Choi
- Department of Health Policy and Management (K Choi), Fielding School of Public Health, UCLA, Los Angeles, Calif; School of Nursing (K Choi), UCLA, Los Angeles, Calif.
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Machtinger EL, Eberhart NK, Ashwood JS, Jones M, Sanchez M, Lightfoot M, Kuo A, Malika N, Leba NV, Williamson S, McCaw B. Clinic Readiness for Trauma-Informed Health Care Is Associated With Uptake of Screening for Adverse Childhood Experiences. Perm J 2024; 28:100-110. [PMID: 38234229 PMCID: PMC10940236 DOI: 10.7812/tpp/23.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are strongly correlated with many of the most common causes of preventable illness, preventable death, and health disparities. In January 2020, California launched the first statewide initiative to integrate ACE screening throughout its Medicaid system. A key element of the initiative was the California ACEs Learning and Quality Improvement Collaborative, a 48-clinic, 16-month learning collaborative. This evaluation aimed to determine whether developing a trauma-informed environment of care was associated with uptake of ACE screening. METHODS Participants included 40 of 48 clinics that participated in the statewide learning collaborative. Clinics completed an assessment of progress in 5 essential components of trauma-informed health care at baseline and 1-year follow-up. Clinics tracked data on ACE screens completed on an ongoing basis and submitted data quarterly. A hierarchical linear model was used to examine the association between change in readiness for trauma-informed health care and change in quarterly screens. RESULTS Readiness for trauma-informed health care increased for all participating clinics over the course of the learning collaborative. The average number of quarterly screens also increased, with considerable variability among clinics. Clinics with larger increases in readiness for trauma-informed health care had larger increases in quarterly screens. DISCUSSION The findings align with long-standing recommendations for trauma screening to occur in the context of trauma-informed environments of care. CONCLUSION A trauma-informed clinic is the foundation for successful adoption of ACE screening. ACE screening initiatives should include education and sufficient support for clinics to embrace a trauma-informed systems change process.
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Affiliation(s)
| | | | | | - Maggie Jones
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Monika Sanchez
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Anda Kuo
- University of California, San Francisco, CA, USA
| | | | | | | | - Brigid McCaw
- University of California, San Francisco, CA, USA
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Stark K, Mathur M, Fok C, Le YC, Hunt ET, McCoy J, Mansoori S, Ukoh N, Keatts S, Fanous E, Eisenhauer R, McKay S. Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics. Acad Pediatr 2024; 24:302-308. [PMID: 38160752 DOI: 10.1016/j.acap.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Social determinants of health (SDOH) significantly affect individuals' health outcomes, yet universal electronic SDOH screening is not standard in primary care. Our study explores the implementation of an electronic SDOH screening in the electronic health record (EHR) and follow-up intervention among primary care pediatric patients within an academic clinic. METHODS Beginning in August of 2022, patients and their families determined to have at least one SDOH need qualified for an in-clinic referral to a coordinated care team member. We assessed the overall efficacy and feasibility of the implementation. RESULTS Over the 4-month pilot, 1473 of 2064 (71.4%) eligible patients were screened, with 472 (32%) patients screening positive on at least one SDOH domain. Of the 472 screened positive, 48 (10.2%) declined a referral. Two hundred and forty-seven of the 424 (58.3%) received a referral to a care coordination team member. CONCLUSIONS This study demonstrates the feasibility of a universal electronic SDOH screening tool within the EHR within an urban, academic-based clinic.
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Affiliation(s)
- Kaitlyn Stark
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Mallika Mathur
- School of Public Health at UTHealth Houston (M Mathur), Houston, Tex.
| | - Christina Fok
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Yen-Chi Le
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Ethan T Hunt
- School of Public Health at UTHealth Houston at Austin (ET Hunt), Austin, Tex.
| | - Jacee McCoy
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Shadhi Mansoori
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Nancy Ukoh
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Sydney Keatts
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Erika Fanous
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Rachel Eisenhauer
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Sandra McKay
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
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Samji H, Long D, Herring J, Correia R, Maloney J. Positive childhood experiences serve as protective factors for mental health in pandemic-era youth with adverse childhood experiences. CHILD ABUSE & NEGLECT 2024:106640. [PMID: 38278687 DOI: 10.1016/j.chiabu.2024.106640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND While adverse childhood experiences (ACEs) predict poorer mental health across the life course, positive childhood experiences (PCEs) predict better mental health. It is unclear whether PCEs protect against poor mental health outcomes and promote mental well-being in pandemic-era adolescents with ACEs. METHODS We examined the individual and joint contributions of ACEs and PCEs to mental health and well-being (MHW) in eleventh-grade British Columbian adolescents (N = 8864) during the fifth wave of COVID-19. We used a novel measure of ACEs that included community- and societal-level ACEs in addition to ACEs experienced at home to investigate the role of social and structural determinants of mental health in supporting the MHW of pandemic-era adolescents. A series of two-way ANCOVAs were conducted comparing MHW outcomes between adolescents with and without ACEs. Interaction effects were examined to investigate whether PCEs moderated the association between ACEs and MHW. RESULTS Adolescents with no ACEs had significantly better MHW than those with one or more ACE. Having six or more PCEs was associated with better MHW in adolescents with and without ACEs. PCEs significantly moderated the association between ACEs and depression. Effect sizes were larger for PCEs than ACEs in relation to depression, mental well-being, and life satisfaction. CONCLUSIONS PCEs may protect against depression among adolescents with ACEs and promote MHW among all pandemic-era adolescents. These findings emphasize the importance of addressing social determinants of mental health to mitigate the impact of ACEs and promote PCEs as part of a public health approach to MHW.
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Affiliation(s)
- Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada; Population and Public Health Division, British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, British Columbia V5Z 4R4, Canada.
| | - David Long
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada; Faculty of Medicine, University of British Columbia, 317 - 2194, Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Jillian Herring
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Rachel Correia
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Jacqueline Maloney
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
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Garcia P, Block A, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy. Cancer Nurs 2024:00002820-990000000-00209. [PMID: 38259094 PMCID: PMC11263502 DOI: 10.1097/ncc.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms. OBJECTIVES The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping. METHODS Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles. RESULTS Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment. CONCLUSIONS More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles. IMPLICATIONS FOR PRACTICE Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.
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Affiliation(s)
- Philip Garcia
- Author Affiliations: School of Nursing, University of California, San Francisco (Mr Garcia, Ms Block, and Drs Mark, Mackin, Paul, Cooper, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Miaskowski and Levine)
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14
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Zogg CK, Runquist EB, Amick M, Gilmer G, Milroy JJ, Wyrick DL, Grimm K, Tuakli-Wosornu YA. Experiences of Interpersonal Violence in Sport and Perceived Coaching Style Among College Athletes. JAMA Netw Open 2024; 7:e2350248. [PMID: 38227316 PMCID: PMC10792469 DOI: 10.1001/jamanetworkopen.2023.50248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/07/2023] [Indexed: 01/17/2024] Open
Abstract
Importance Concern about interpersonal violence (IV) in sport is increasing, yet its implications remain poorly understood, particularly among currently competing college athletes. Objective To document the self-reported prevalence of IV in college sports; identify associated risk factors; examine potential consequences associated with athletes' psychosocial well-being, emotional connection to their sport, and willingness to seek help; and explore the associations between IV reporting and perceived variations in coaching styles. Design, Setting, and Participants This survey study analyzes results of the 2021 to 2022 National Collegiate Athletic Association (NCAA) myPlaybook survey, which was administered from July to December 2021 to 123 colleges and universities across the US. Participants were NCAA athletes aged 18 to 25 years who were current players on an NCAA-sanctioned team. Exposures Self-reported demographic characteristics (eg, athlete gender identity and sexual orientation) and perceived differences in supportive vs abusive coaching styles (eg, athlete autonomy, team culture, and extent of abusive supervision). Main Outcomes and Measures The primary outcome was self-reported experiences of IV in sport during the college sports career of currently competing college athletes. Types of IV considered were physical abuse, financial abuse, sexual abuse, psychological or emotional abuse, and neglect or abandonment. Outcomes potentially affected by IV were assessed with 4 questionnaires. Results A total of 4119 athletes (mean [SD] age, 19.3 [1.5] years; 2302 males [55.9%]) completed the survey (response rate, 21.2%). One in 10 athletes (404 of 4119 [9.8%]) reported experiencing at least 1 type of IV during their college sports career, of whom two-thirds (267 [6.5%]) experienced IV within the past 6 weeks. On multivariable analysis, female gender identity (odds ratio [OR], 2.14; 95% CI, 1.46-3.13), nonheterosexual sexual orientation (OR, 1.56; 95% CI, 1.01-2.42), increasing age beyond 18 years (OR, 1.13; 95% CI, 1.01-1.30), increasing year of NCAA eligibility beyond the first year (OR, 1.19; 95% CI, 1.02-1.39), and participation in select sports (eg, volleyball: OR, 2.77 [95% CI, 1.34-5.72]; ice hockey: OR, 2.86 [95% CI, 1.17-6.95]) were independently associated with IV. When exposed to IV, college athletes reported experiencing consistently worse psychosocial outcomes, including increased burnout (mean difference on a 5-point Likert scale, 0.75; 95% CI, 0.63-0.86; P < .001) and an expressed desire to consider quitting their sport (mean difference, 0.81; 95% CI, 0.70-0.92; P < .001). They were not, however, less willing to seek help. Differences in coaching style were associated with differences in IV reporting. In risk-adjusted linear regression models, having a more supportive coach was associated with a 7.4 (95% CI, 6.4-8.4) absolute percentage point decrease in athletes' probability of reporting experiencing IV. In contrast, having a more abusive coach was associated with up to a 15.4 (95% CI, 13.8-17.1) absolute percentage point increase in athletes' probability of reporting experiencing IV. Conclusions and Relevance Results of this survey study suggest that IV is associated with marked changes in the psychosocial health and emotional well-being of college athletes, particularly those who identify as female and with nonheterosexual sexual orientations. Variations in coaching style have the potential to alter these associations. Ongoing efforts are needed to leverage the unique position that coaches hold to help reduce IV and create safe places where all college athletes can thrive.
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Affiliation(s)
- Cheryl K. Zogg
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Edward B. Runquist
- Department of Sports Medicine, Drexel School of Medicine, Philadelphia, Pennsylvania
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Gabrielle Gilmer
- Cellular and Molecular Pathology Graduate Program, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffery J. Milroy
- Institute to Promote Athlete Health & Wellness, University of North Carolina Greensboro, Greensboro
| | - David L. Wyrick
- Institute to Promote Athlete Health & Wellness, University of North Carolina Greensboro, Greensboro
| | | | - Yetsa A. Tuakli-Wosornu
- Sports Equity Lab, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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15
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Tuakli-Wosornu YA, Galea NR, Forsdike K, MacLeod JG. Methodological and ethical limitations of interpersonal violence research in Sports and Exercise Medicine: advancing an athlete-centred approach. Br J Sports Med 2023; 57:1537-1538. [PMID: 37286309 DOI: 10.1136/bjsports-2023-106754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Yetsa A Tuakli-Wosornu
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Natalie R Galea
- Faculty of Architecture, Building and Planning, University of Melbourne (AUS), Melbourne, Victoria, Australia
| | - Kirsty Forsdike
- La Trobe Business School, La Trobe University (AUS), Melbourne, Victoria, Australia
| | - Jelena G MacLeod
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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Campbell AC, Pearce LA, Willoughby M, Borschmann R, Young J, Bruun A, Sundbery J, Kinner SA. Adverse childhood experiences, morbidity, mortality and resilience in socially excluded populations: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074314. [PMID: 37848305 PMCID: PMC10582898 DOI: 10.1136/bmjopen-2023-074314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Socially excluded populations, defined by homelessness, substance use disorder, sex work or criminal justice system contact, experience profound health inequity compared with the general population. Cumulative exposure to adverse childhood experiences (ACEs), including neglect, abuse and household dysfunction before age 18, has been found to be independently associated with both an increased risk of social exclusion and adverse health and mortality outcomes in adulthood.Despite this, the impact of ACEs on health and mortality within socially excluded populations is poorly understood. METHODS AND ANALYSIS We will search MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, Applied Social Science Index and Abstracts and Criminal Justice Database for peer-reviewed studies measuring ACEs and their impact on health and mortality in socially excluded populations.Three review questions will guide our data extraction and analysis. First, what is the prevalence of ACEs among people experiencing social exclusion in included studies? Second, what is the relationship between ACEs and health and mortality outcomes among people experiencing social exclusion? Does resilience modify the strength of association between ACEs and health outcomes among people experiencing social exclusion?We will meta-analyse the relationship between ACE exposure and health outcomes classified into six a prior categories: (1) substance use disorders; (2) sexual and reproductive health; (3) communicable diseases; (4) mental illness; (5) non-communicable diseases and (6) violence victimisation, perpetration and injury. If there are insufficient studies for meta-analysis, we will conduct a narrative synthesis. Study quality will be assessed using the MethodologicAl STandards for Epidemiological Research scale. ETHICS AND DISSEMINATION Our findings will be disseminated in a peer-reviewed journal, in presentations at academic conferences and in a brief report for policy makers and service providers. We do not require ethics approval as this review will use data that have been previously published. PROSPERO REGISTRATION NUMBER CRD42022357565.
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Affiliation(s)
- Alexander Charles Campbell
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lindsay A Pearce
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa Willoughby
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Psychiatry, Oxford University, Oxford, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Andrew Bruun
- Youth Support and Advocacy Service, Melbourne, Victoria, Australia
| | - Jacqui Sundbery
- Youth Support and Advocacy Service, Melbourne, Victoria, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
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Alvarado G, McBain R, Chen P, Estrada-Darley I, Engel C, Malika N, Machtinger E, McCaw B, Thyne S, Thompson N, Shekarchi A, Lightfoot M, Kuo A, Benedict D, Gantz L, Perry R, Kannan I, Yap N, Eberhart N. Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics. Ann Fam Med 2023; 21:416-423. [PMID: 37748912 PMCID: PMC10519753 DOI: 10.1370/afm.3014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care. METHODS We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals. RESULTS Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening. CONCLUSIONS Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.
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Affiliation(s)
| | | | - Peggy Chen
- Rand Corporation, Santa Monica, California
| | | | - Charles Engel
- University of Washington School of Medicine, Seattle, Washington
| | | | | | - Brigid McCaw
- University of California, San Francisco, California
| | - Shannon Thyne
- Olive View-University of California Los Angeles Medical Center, Los Angeles, California
| | - Nina Thompson
- Olive View-University of California Los Angeles Medical Center, Los Angeles, California
| | - Amy Shekarchi
- Olive View-University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Anda Kuo
- University of California, San Francisco, California
| | - Darcy Benedict
- Harbor-University of California Los Angeles Medical Center, Los Angeles, California
| | - Lisa Gantz
- Los Angeles County Department of Health Services, Los Angeles, California
| | - Raymond Perry
- Los Angeles County Department of Health Services, Los Angeles, California
| | - Indu Kannan
- Los Angeles County Department of Health Services, Los Angeles, California
| | - Nancy Yap
- Los Angeles County Department of Health Services, Los Angeles, California
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Ye M, Hessler D, Ford D, Benson M, Koita K, Bucci M, Long D, Harris NB, Thakur N. Pediatric ACEs and related life event screener (PEARLS) latent domains and child health in a safety-net primary care practice. BMC Pediatr 2023; 23:367. [PMID: 37461038 PMCID: PMC10351141 DOI: 10.1186/s12887-023-04163-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome. METHODS Participants (3 months-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models. RESULTS Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms. CONCLUSION In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.
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Affiliation(s)
- Morgan Ye
- San Francisco Departments of Medicine and Epidemiology and Biostatistics, University of California, 500 Parnassus Avenue, 94143-0841 San Francisco, CA USA
| | - Danielle Hessler
- San Francisco Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, 94143 San Francisco, CA USA
| | - Derek Ford
- Center for Psychological and Social Health, LLC, 2918 Westover Dr, Danville, VA 24541 USA
| | - Mindy Benson
- San Francisco Department of Pediatrics, University of California, 5220 Claremont Ave, Oakland, CA 94609 USA
| | - Kadiatou Koita
- Center for Youth Wellness, 3450 3rd St, 94124 San Francisco, CA USA
| | - Monica Bucci
- Center for Youth Wellness, 3450 3rd St, 94124 San Francisco, CA USA
| | - Dayna Long
- San Francisco Department of Pediatrics, University of California, 5220 Claremont Ave, Oakland, CA 94609 USA
| | | | - Neeta Thakur
- San Francisco Departments of Medicine and Epidemiology and Biostatistics, University of California, 500 Parnassus Avenue, 94143-0841 San Francisco, CA USA
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Walsh BM, Grobbel H, Christ SL, Tichenor SE, Gerwin KL. Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2278-2295. [PMID: 37390495 PMCID: PMC10468119 DOI: 10.1044/2023_jslhr-23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore. METHOD One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement. RESULTS Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings. CONCLUSIONS These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23582172.
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Ronis S, Guyon-Harris KL, Burkhart K, Gabriel M, Cipolla K, Riggs JL, Huth-Bocks A. Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1023. [PMID: 37371255 DOI: 10.3390/children10061023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.
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Affiliation(s)
- Sarah Ronis
- UH Rainbow Center for Child Health and Policy, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Katherine L Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kimberly Burkhart
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Mary Gabriel
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Kristin Cipolla
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jessica L Riggs
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alissa Huth-Bocks
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Merrill Palmer Skillman Institute, Division of Research, Wayne State University, Detroit, MI 48202, USA
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21
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Tang JT, Saadi A, Dunn EC, Choi K. Concordance in Child-Parent Reporting of Social Victimization Experiences in the Adolescent Brain Cognitive Development Study. Acad Pediatr 2023; 23:747-754. [PMID: 36182088 PMCID: PMC10043040 DOI: 10.1016/j.acap.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate child-parent concordance in reporting social victimization experiences and whether concordance was associated with child behavioral symptoms. METHODS This was an observational study with data from the Adolescent Brain Cognitive Development study. The analytic sample was 11,235 9- or 10-year-old children from the United States. Exposure variables were demographic and protective factors (child perceptions of parental relationships, school protective factors, neighborhood safety). The outcome was parent-child concordance on 6 domains of child social victimization: conventional crime, peer victimization, witnessing violence, internet victimization, school victimization, and gun violence. Child behavior symptoms were measured using the Child Behavior Checklist. RESULTS Exposure to social victimization was low (9% of the sample). Concordance ranged from 18% to 50%. The highest levels of concordance were observed for conventional crime (k = 0.48, P < .001) and witnessing violence (k = 0.48, P < .001). Parents' perceptions of greater neighborhood safety was associated with lower odds of concordant conventional crime (odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.86-0.99) and witnessing violence (OR = 0.92, 95% CI0.84-0.99). Concordance was associated with more internalizing/externalizing behaviors. CONCLUSIONS Parents under-report social victimization in relation to children. Concordance in reporting social victimization may be an indicator of the severity of experiences, underscoring the need to consider child reports when screening for adversity.
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Affiliation(s)
- Judy T Tang
- Keck Medicine of USC (JT Tang), Los Angeles, Calif
| | - Altaf Saadi
- Department of Neurology (A Saadi), Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Erin C Dunn
- Center for Genomic Medicine (EC Dunn), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (EC Dunn), Harvard Medical School, Boston, Mass; Harvard Center on the Developing Child (EC Dunn), Cambridge, Mass
| | - Kristen Choi
- Department of Health Policy and Management (K Choi), Fielding School of Public Health, UCLA, Los Angeles, Calif; School of Nursing (K Choi), UCLA, Los Angeles, Calif.
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22
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Thomas JL, Colich NL, McLaughlin KA, Sumner JA. Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample. J Adolesc Health 2023; 72:560-567. [PMID: 36529620 PMCID: PMC11107430 DOI: 10.1016/j.jadohealth.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Early life adversity (ELA) is associated with sexual risk, but ELA dimensions-and potential mechanisms-have been less examined. We evaluated associations between threat and deprivation-two key ELA dimensions-and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. METHODS Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche. RESULTS Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62-1.92]) and deprivation (OR = 1.51 [95% CI, 1.24-1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = -0.20 [95% CI, -0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10-0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64-0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche. DISCUSSION Although threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health.
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Affiliation(s)
- Jordan L Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California.
| | - Natalie L Colich
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | | | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California
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23
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Ferro RA, DiFatta R, Khan KN, Coble K, Reinblatt SP, Bettencourt AF. When Adverse Childhood Experiences Present to a Statewide Child Psychiatry Access Program. J Behav Health Serv Res 2023; 50:400-412. [PMID: 37002438 DOI: 10.1007/s11414-023-09836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
Abstract Many children experience adversity, yet few receive needed psychiatric services. Pediatric primary care providers (PCPs) are uniquely positioned to intervene but often lack training and resources to provide patients with adverse childhood experiences (ACEs) the psychiatric support they need. The current study examines characteristics of youth with and without ACEs who were the focus of PCP contacts with a statewide child psychiatry access program (CPAP). Compared to those without ACEs, patients with ACEs were more often receiving medication treatment at time of CPAP contact, prescribed two or more psychotropic medications, and diagnosed with two or more mental health disorders. Study findings indicate that patients with ACEs for whom PCPs sought CPAP support were experiencing more clinically severe and complex mental health concerns. These findings underscore the important role of CPAPs in supporting PCPs with pediatric patients who have ACEs and will inform training provided by CPAPs to PCPs.
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24
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The Role of the Mind-Body Connection in Children with Food Reactions and Identified Adversity: Implications for Integrating Stress Management and Resilience Strategies in Clinical Practice. CHILDREN 2023; 10:children10030563. [PMID: 36980121 PMCID: PMC10047561 DOI: 10.3390/children10030563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Child adversity is often associated with poor quality of life in pediatric gastrointestinal disorders, including non-allergic food reactions (food intolerances), which may be improved using mind-body interventions. We conducted an observational study to (1) describe child adversity (stressors) and resilience factors in children with food intolerances, and (2) explore the association between stressors and self-reported use of integrative modalities. A retrospective chart review of children ≥4-years-old presenting to a pediatric food intolerances clinic from 2017 to 2020 was performed (n = 130). Use of integrative medicine at intake, demographic, illness, and social history data were collected. Qualitative analysis identified exposure to stressors and resilience strategies. Correlation was assessed using a chi-square test. Management of the medical condition was the most common stressor, indicating impact on quality of life. Resilience strategies included themes of self-coping and social support. Individuals with one or more stressors were more likely to be using an integrative modality (most commonly, mind-body interventions) prior to their visit (X2 = 8.1, p = 0.004). Our hypothesis-generating study suggests that screening for child adversity and integrative medicine use may be used to better address quality of life and personalized approaches to treat pediatric food intolerances.
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25
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Bravo LG, Ahmed C, Choi K. Addressing Social Context in Adverse Childhood Experience Screening Policy: Implications for Children With Special Health Care Needs. J Pediatr Health Care 2023; 37:213-216. [PMID: 36460544 DOI: 10.1016/j.pedhc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
Adverse childhood experiences (ACEs) disproportionately affect children with special health care needs, especially racial and ethnic minority children whose ACEs may be less likely to be identified. As awareness and understanding of the health impacts of ACEs have increased, heightened by the COVID-19 pandemic, several areas of the United States have initiated policy efforts to screen for and address ACEs. However, these policies do not always include mechanisms to account for context-specific adversity or contemporary stressors in the lives of children. Stressors most significant in a child's life may include adversities beyond those included in common ACE screening instruments. ACE policy in California will be discussed relative to addressing the social context in ACEs screening. By taking a holistic view of ACEs and thinking beyond deriving ACE scores alone, clinicians can ensure that ACE-related policies are implemented with maximum benefit to diverse children with special health care needs.
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26
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Morse L, Paul SM, Cooper BA, Oppegaard K, Shin J, Calvo-Schimmel A, Harris C, Hammer M, Conley Y, Wright F, Levine JD, Kober KM, Miaskowski C. Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity. J Pain Symptom Manage 2023; 65:203-215. [PMID: 36423801 PMCID: PMC11189665 DOI: 10.1016/j.jpainsymman.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. OBJECTIVES Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. METHODS Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. RESULTS Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. CONCLUSION To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.
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Affiliation(s)
- Lisa Morse
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Joosun Shin
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts
| | - Yvette Conley
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fay Wright
- Rory Meyers College of Nursing (F.W.), New York University, New York, New York
| | - Jon D Levine
- School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California;; School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA.
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Abstract
Trauma is common within the United States. It is important for individuals to understand how trauma may affect their health and how trauma in childhood can have adverse effects on a child's development and health. To reduce retraumatization of patients, it is imperative to use trauma-informed approaches in a clinical encounter. Screening is an effective way to understand a patient's trauma history. When screening for trauma, it is important to take a family-centered approach and provide appropriate referrals if a patient screens positive for trauma. Primary care providers are essential players in addressing and preventing trauma.
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28
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Parmar DD, Minnis AM, Caballero E, Zerofsky M, Comfort M, Raymond-Flesch M. Latina mothers' perspectives on adverse experiences and protection of Latinx youth in an agricultural community. BMC Public Health 2023; 23:223. [PMID: 36732714 PMCID: PMC9893687 DOI: 10.1186/s12889-023-14993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are a measure of childhood toxic stress that have a dose-dependent relationship with many adult health outcomes. While ACEs have been validated across diverse populations to measure neglect, abuse, and family dysfunction, they do not specifically assess trauma related to racism/xenophobia and immigration. 54% of Latinx youth in the United States are immigrants or children of immigrants and a large group with potentially unmeasured trauma. This study looks beyond ACEs to identify adverse and protective factors for healthy development among Latinx youth in an agricultural community through the perspectives of their mothers. METHODS Twenty mothers of adolescent participants in A Crecer: the Salinas Teen Health Study (a prospective cohort study of 599 adolescents) completed semi-structured interviews in Spanish. Interviews focused on mothers' perspectives on community resources, parenting strategies, parenting support systems, and their future aspirations for their children. Four coders completed iterative rounds of thematic coding drawing from published ACEs frameworks (original ACEs, community ACEs) and immigrant specific adverse events arising from the data. RESULTS Mothers in this study reported adverse experiences captured within community-level ACEs but also distinct experiences related to intergenerational trauma and immigrant-related adversities. The most cited community-level ACEs were housing instability and community violence. Immigrant related adversities included experiences of systemic racism with loss of resources, political instability limiting structural resources, and language-limited accessibility. These were exacerbated by the loss of family supports due to immigration related family-child separation including deportations and staggered parent-child migration. Having experienced intergenerational trauma and systemic oppression, mothers discussed their strategies for building family unity, instilling resilience in their children, and improving socioeconomic opportunities for their family. CONCLUSIONS Latina mothers shared the impacts of immigrant-related experiences on systemic inequities in the United States which are currently missing from the ACEs framework. Immigrant specific adverse events include language-limited accessibility, or family-child separations, and policies impacting structural resources for immigrant families. Mothers highlighted their capacity to build resilience in their children and buffer impacts of systemic racism. Community-tailored interventions can build on this foundation to reduce health disparities and promote health equity in this population.
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Affiliation(s)
- Deepika D. Parmar
- grid.266102.10000 0001 2297 6811Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA USA
| | | | - Elodia Caballero
- grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Melissa Zerofsky
- grid.266102.10000 0001 2297 6811Department of Pediatrics, University of California, San Francisco, San Francisco, CA USA
| | - Megan Comfort
- grid.62562.350000000100301493RTI International, Berkeley, CA USA
| | - Marissa Raymond-Flesch
- grid.266102.10000 0001 2297 6811Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA USA
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29
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de la Rosa R, Zablotny D, Ye M, Bush NR, Hessler D, Koita K, Bucci M, Long D, Thakur N. Biological Burden of Adverse Childhood Experiences in Children. Psychosom Med 2023; 85:108-117. [PMID: 36728584 PMCID: PMC9930178 DOI: 10.1097/psy.0000000000001167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population. METHODS Children were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health. RESULTS Children (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89). CONCLUSIONS Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.
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Affiliation(s)
- Rosemarie de la Rosa
- From the Department of Medicine (de la Rosa, Zablotny, Ye, Thakur), University of California San Francisco, San Francisco; School of Public Health (de la Rosa), University of California Berkeley, Berkeley; Departments of Psychiatry and Behavioral Science (Bush) and Pediatrics (Bush and Long) and Family and Community Medicine (Hessler), University of California San Francisco, San Francisco; UCSF Benioff Children's Hospital Oakland (Long), Oakland; Center for Youth Wellness (Koita, Bucci), San Francisco, California
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30
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Raising the bar for measuring childhood adversity. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:81-83. [PMID: 36265505 DOI: 10.1016/s2352-4642(22)00301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
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Martinez A, Thakur N. Structural Racism and the Social Determinants of Health in Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:101-115. [PMID: 37464118 DOI: 10.1007/978-3-031-32259-4_5] [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: 07/20/2023]
Abstract
Asthma prevalence and morbidity are disproportionately higher among minoritized communities in the United States. Racial and ethnic disparities in asthma result from complex interactions across biological, environmental, and social factors. Asthma is considered a complex heterogeneous disease consisting of different phenotypes, some of which may be more common in individuals impacted by the downstream effects of structural racism and lack of access to the social determinants of health. Structural racism across generations has created and reinforced inequitable systems through policies and practices which are embedded in the economic, educational, health care, and justice systems (Bailey et al., N Engl J Med 384(8):768-773, 2021; Bailey et al., Lancet 389:1453-1463, 2017; Williams et al., Annu Rev Public Health 40:105-125, 2019). This manifests in an inequitable distribution of resources and the social determinants of health affecting an individual's physical and social environment (Bailey et al., Lancet 389:1453-1463, 2017; Thakur et al., Am J Respir Crit Care Med 202:943-949, 2020; Martinez et al., J Allergy Clin Immunol 148(5):1112-1120, 2021). In this chapter, we outline how inequity in housing, zoning laws, urban planning, education, employment, healthcare access, and healthcare delivery is linked to higher asthma prevalence and morbidity. We also describe the role that chronic physiologic stress has on asthma by enhancing neuroimmune and immunologic responses to environmental exposures. Interventions aimed at addressing the physical or social environment of an individual or community have been shown to improve asthma outcomes in patients at higher risk of severe disease.
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Affiliation(s)
- Adali Martinez
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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32
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Rothman EF, Lynch AK. The State of the Science on Adverse Childhood Experiences. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:6-13. [PMID: 36082458 DOI: 10.1177/15394492221120799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the "Positive Childhood Experiences" (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.
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33
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Munzer T, Torres C, Domoff SE, Levitt KJ, McCaffery H, Schaller A, Radesky JS. Child Media Use During COVID-19: Associations with Contextual and Social-Emotional Factors. J Dev Behav Pediatr 2022; 43:e573-e580. [PMID: 36106745 PMCID: PMC9712155 DOI: 10.1097/dbp.0000000000001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to test associations between (1) contextual factors and types of digital media use and (2) types of digital media use and children's social-emotional and sleep outcomes during COVID-19. METHODS In February to March 2021, 303 parents of elementary schoolers participated in this cross-sectional survey gathering information on demographics, child school format, contextual factors, duration of types of digital media use, social-emotional outcomes, and sleep. Multivariable regressions examined associations outlined in the objective, adjusting for school format, only child, race/ethnicity, and parental stress, depressive symptoms, education, and material hardship. RESULTS Children were aged 5 years to younger than 11 years and spent approximately 4 hours on screen media daily. In multivariable analyses, remote school format; greater material hardship; Black, Indigenous, and people of color child race/ethnicity; lower parenting stress; and parent depressive symptoms were associated with longer duration of various digital media. Longer daily duration of streaming video and video chat were associated with higher prosocial scores, while console games, mobile apps/games, and video-sharing platforms were associated with greater problematic media use (PMU) (defined as interfering with adaptive functioning). More time on mobile apps/games, video-sharing platforms, and video streaming was linked with shorter sleep. CONCLUSION Lower parenting stress predicted greater digital media use. Greater digital media use during the pandemic may have enabled parents to focus on other needs. Use of media for social connection predicted greater prosocial behaviors. Engagement-prolonging digital media predicted PMU. Pediatric providers may wish to consider family context when addressing digital media use and encourage socially oriented digital media.
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Affiliation(s)
- Tiffany Munzer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Chioma Torres
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Sarah E. Domoff
- Department of Psychology, Central Michigan University, Mount Pleasant, MI
| | - Kimberley J. Levitt
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Harlan McCaffery
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Alexandria Schaller
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Jenny S. Radesky
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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Lopez-Tamayo R, Suarez L, Simpson D, Volpe K. The Impact of Adverse Childhood Experiences and Community Violence Exposure on a Sample of Anxious, Treatment-Seeking Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1081-1093. [PMID: 36439664 PMCID: PMC9684382 DOI: 10.1007/s40653-022-00447-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 06/16/2023]
Abstract
Screening for adverse childhood experiences (ACEs) can help prevent and reduce adverse outcomes on child development, including increased risk for anxiety disorders. Emerging studies strongly support the inclusion of community-level adversities in ACE screeners to consider diverse contexts and populations. Recent studies suggest that community violence exposure (CVE) may have a distinct impact on youth mental health. Although recent studies have examined the association between ACEs, CVE, and mental health in primary care settings, this association has not been examined on treatment-seeking children in urban mental health settings. The present study employs a mediation model using the PROCESS macro to examine community violence exposure mediating the effect on the association between ACEs and somatic symptoms (SS) on a sample of anxious treatment-seeking children. A total of 98 participants (Mage = 11.7, SD = 3.79, 51.6% males, 54.1% ethnic minority children) who sought services at a specialized anxiety clinic completed self-report measures. Results indicated that exposure to ACEs is associated with endorsement of somatic symptoms as a result of reporting hearing, witnessing, or experiencing CVE. Evidence of mediation was found in a statistically significant indirect effect of ACEs on SS through CREV (Effect = .17, 95% CI = .069-.294). These findings support recent evidence that CVE is a distinct ACE as it contributes to toxic stress similar to individual-level ACEs. The use of a comprehensive ACE screening that includes CVE is warranted, particularly when working with culturally and socioeconomically diverse populations, as it would better capture a broader range of adversities across demographic groups.
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Affiliation(s)
- Roberto Lopez-Tamayo
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
| | - Liza Suarez
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
| | | | - Kelley Volpe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois USA
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Yaun JA, Rogers LW, Marshall A, McCullers JA, Madubuonwu S. Whole Child Well-Child Visits: Implementing ACEs and SDOH Screenings in Primary Care. Clin Pediatr (Phila) 2022; 61:542-550. [PMID: 35499122 PMCID: PMC9315173 DOI: 10.1177/00099228221093279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adverse childhood experiences (ACEs) and social determinants of health (SDOH) negatively affect health outcomes. This program was developed to screen for ACEs and SDOH in the primary care setting in families with children 9 months to 5 years of age at well-child checks and provide interventions that support families and build resiliency. Programmatic criteria were identified, referral resources were developed, and a database was implemented, with 246 families enrolled in year 1; 56.9% of caregivers reported 1 or more ACEs for their child, 63% of caregivers reported an SDOH need, and 39.4% of caregivers reported both. The average number of ACEs was 0.94. This program was created to address ACEs and SDOH, to empower families, build resiliency, and provide buffers to mitigate and prevent ACEs. It provides a model that can be implemented in a primary care setting while providing wraparound resources, including integrated mental health resources and referrals, to measure the success of these interventions.
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Affiliation(s)
- Jason A. Yaun
- Methodist Le Bonheur Healthcare,
Memphis, TN, USA,Department of Pediatrics, University of
Tennessee Health Science Center, Memphis, TN, USA,Jason A. Yaun, Department of Pediatrics,
University of Tennessee Health Science Center, 49 North Dunlap, Room 162,
Memphis, TN 38103, USA.
| | | | | | - Jonathan A. McCullers
- Methodist Le Bonheur Healthcare,
Memphis, TN, USA,Department of Pediatrics, University of
Tennessee Health Science Center, Memphis, TN, USA
| | - Sandra Madubuonwu
- Methodist Le Bonheur Healthcare,
Memphis, TN, USA,College of Graduate Health Sciences,
University of Tennessee Health Science Center, Memphis, TN, USA
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36
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Lynch T, Davis SL, Johnson AH, Gray L, Coleman E, Phillips SR, Soistmann HC, Rice M. Definitions, theories, and measurement of stress in children. J Pediatr Nurs 2022; 66:202-212. [PMID: 35868219 PMCID: PMC10085063 DOI: 10.1016/j.pedn.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
PROBLEM Stress in children remains a complex concept to examine due to the inherent subjectivity and lack of specific manifestations, as well as the multiple ways stress can be defined and measured in children. Because stress is multifactorial,is experienced daily by children, and undergirds adolescent health and early mental illness, it is crucial to have a clear understanding of stress and the effects of stress in children from infancy through age twelve years. ELIGIBILITY CRITERIA To be included in this review, literature must pertain to and highlight theories, definitions/classifications, and measurements of stress in children from infancy to 12 years of age. SAMPLE The most pertinent articles identified through database searches (PubMed, Scopus, PsycINFO, CINAHL, Google Scholar), gray literature sources (e.g., child health websites), and reference lists of identified articles were included in this narrative overview. RESULTS The results of this review are organized by themes and include: classifications and definitions of stress, stress-related theories, and tools to measure stress in children. CONCLUSIONS Research addressing stressors and stress in children is limited, and there is wide variation in how researchers define and classify stress in children. Existing measures of stress in children younger than 12 address physiological, psychological, and observational components, but may be inconsistent and threaten validity of otherwise well-designed and well-executed studies. IMPLICATIONS Improving the understanding and accurate measurement of stress in children enables researchers and clinicians to curtail undesirable health outcomes.
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Affiliation(s)
- Thuy Lynch
- University of Alabama in Huntsville, 301 Sparkman Drive, Huntsville, AL 35899, USA.
| | - Sara L Davis
- University of South Alabama, 5721 USA Drive, N., Mobile, AL 36688, USA.
| | - Ann Hammack Johnson
- Harris College of Nursing and Health Sciences, Texas Christian University, 2800 S. University Drive, Fort Worth, TX 76109, USA.
| | - Laura Gray
- Gordon E. Inman College of Health Sciences and Nursing, Belmont University, 1900 Belmont Boulevard, Nashville, TN 37212, USA.
| | - Elizabeth Coleman
- University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL 35294, USA.
| | | | - Heather C Soistmann
- Penn State Health Children's Hospital, 500 University Drive, Hershey, PA 17033, USA.
| | - Marti Rice
- University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL 35294, USA.
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37
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Guerrero A, Herman A, Teutsch C, Dudovitz R. Improving Knowledge and Attitudes About Child Trauma Among Parents and Staff in Head Start Programs. Matern Child Health J 2022; 26:2237-2246. [PMID: 36002698 PMCID: PMC9401194 DOI: 10.1007/s10995-022-03473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/06/2022]
Abstract
Background Early childhood represents a sensitive developmental period when trauma-informed care may mitigate the effects of trauma on developmental and health outcomes. However, few interventions use a low-literacy scalable approach to improve child trauma knowledge and attitudes among parents and early childcare and education caregivers.
Methods Representatives from 24 early head start (EHS) and head start (HS) agencies attended a 2 day online train-the trainer session and then delivered a child trauma and resilience training to staff at their sites, with the option to deliver a similar training to parents. Baseline and 3 month post-training surveys assessed participant knowledge and attitudes regarding childhood trauma and resilience. Paired T-tests and chi2 analyses assessed changes in responses over time. Results Thousand five hundred sixty seven staff from 24 agencies and 443 parents from 7 agencies completed baseline and follow up surveys. Over 55% of parents reported their child had experienced at least one adverse childhood experience. Staff and parents had high knowledge regarding causes of trauma at baseline. Both staff and parents, demonstrated significant improvements in identifying symptoms of child trauma. Staff also improved knowledge of resiliency and toxic stress. Parents reported more positive attitudes towards trauma-informed parenting practices. Conclusion This is the first training on childhood trauma among EHS/HS providers and parents using a low literacy train-the-trainer approach. Results suggest a potentially promising methodology with broad dissemination potential to prepare and train the one million plus teachers and caregivers in center-based settings and the parents and families who access them to recognize and respond to child trauma. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03473-8.
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Affiliation(s)
- A Guerrero
- Department of Pediatrics and Children's Discovery and Innovations Institute, David Geffen School of Medicine, UCLA Mattel Children's Hospital, 10833 LeConte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA
| | - A Herman
- UCLA Health Care Institute, Anderson School of Management, University of California Los Angeles, 110 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - C Teutsch
- UCLA Health Care Institute, Anderson School of Management, University of California Los Angeles, 110 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - R Dudovitz
- Department of Pediatrics and Children's Discovery and Innovations Institute, David Geffen School of Medicine, UCLA Mattel Children's Hospital, 10833 LeConte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA.
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38
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A Caregiver-Child Intervention for Mitigating Toxic Stress ("The Resiliency Clinic"): A Pilot Study. Matern Child Health J 2022; 26:1959-1966. [PMID: 35947275 PMCID: PMC9489544 DOI: 10.1007/s10995-022-03485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/16/2022] [Accepted: 07/20/2022] [Indexed: 12/03/2022]
Abstract
Introduction Primary care-based interventions that promote nurturing caregiving relationships and early relational health may help mitigate toxic stress and promote resilience in children. This pilot study aims to: (1) describe a novel group-based, psychoeducational primary care intervention for children experiencing adverse childhood experiences (ACEs) (“The Resiliency Clinic”), (2) assess program feasibility and acceptability, and (3) explore effects on child/caregiver behavioral health. Methods Intervention design centered on promoting supportive caregiving, caregiver/child self-regulation and co-regulation and teaching evidence-based stress management tools. Program feasibility and acceptability were assessed through attendance data and caregiver focus groups. Behavioral health measures were obtained at baseline and 8-month follow-up. Results Of 101 eligible families, 38 (37.6%) enrolled and attended a median of 3.00 (mean = 2.95, sd = 1.75) out of 6 sessions. Caregivers reported high satisfaction and benefits including stress management tools and connection with staff and other parents. There were modest, statistically non-significant improvements in caregiver stress (d = 0.23) and child executive functioning (d = 0.27). Discussion In conclusion, a group intervention teaching supportive caregiving and stress mitigation is feasible and acceptable for many families in an urban federally qualified health center (FQHC) with a signal for modest improvements in behavioral health. Future program iterations will seek to address participation barriers and expand the intervention’s capacity to promote early relational health.
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Levitt KJ, Munzer T, Torres C, Schaller A, McCaffery H, Radesky JS. Remote and Hybrid Schooling During COVID-19: Associations with Child Behavior and Sleep. J Dev Behav Pediatr 2022; 43:e288-e295. [PMID: 35583945 PMCID: PMC10186251 DOI: 10.1097/dbp.0000000000001085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the prevalence of child behavior, academic and sleep concerns, and parent stress and depression symptoms during COVID-19; to test associations of parent-child well-being with child school format; and to examine effect moderation by child race/ethnicity and material hardship. METHODS A total of 305 English-speaking parents of elementary school-age children completed online surveys regarding demographics, child school format, behavior, learning-related experiences, sleep, and parent stress and depression symptoms. Multivariable linear and logistic regression analyses examined associations of school format with child and parent outcomes. RESULTS Children were aged 5.00 to 10.99 years, with 27.8% underrepresented minority race/ethnicity. Per parental report, 27.7% attended school in-person, 12.8% hybrid, and 59.5% remote. In multivariable models, compared with children receiving in-person instruction, children receiving remote instruction exhibited more hyperactivity (β 0.94 [95% confidence interval, 0.18-1.70]), peer problems (β 0.71 [0.17-1.25]), and total behavioral difficulties (β 2.82 [1.11-4.53]); were less likely to show academic motivation (odds ratio [OR] 0.47 [0.26-0.85]) and social engagement (OR 0.13 [0.06-0.25]); were more likely to show schoolwork defiance (OR 2.91 [1.56-5.40]); and had a later sleep midpoint (β 0.37 [0.18-0.56]) and higher odds of cosleeping (OR 1.89 [1.06-3.37]). Associations of remote learning with behavior difficulties were stronger for children without material hardships. CONCLUSION Children receiving remote and hybrid instruction were reported to have more difficulties compared with children receiving in-person instruction. Children with material hardships showed more behavior challenges overall but less associated with school format. Therefore, planning for a return to in-person learning should also include consideration of family supports.
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Affiliation(s)
- Kimberley J. Levitt
- Division of Developmental Behavioral Pediatrics, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Tiffany Munzer
- Division of Developmental Behavioral Pediatrics, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Chioma Torres
- Division of Developmental Behavioral Pediatrics, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Alexandria Schaller
- Division of Developmental Behavioral Pediatrics, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Harlan McCaffery
- Department of Pediatrics, University of Michigan Medical
School, Ann Arbor, MI
| | - Jenny S. Radesky
- Division of Developmental Behavioral Pediatrics, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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40
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Durbin A, Amaechi BT, Abrams S, Mandelis A, Werb S, Roebuck B, Durbin J, Wang R, Daneshvarfard M, Sivagurunathan K, Bozec L. Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063403. [PMID: 35329091 PMCID: PMC8948931 DOI: 10.3390/ijerph19063403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Background: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case–control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. Methods: For 150 mother–child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child’s adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. Conclusion: If structural changes in children’s teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.
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Affiliation(s)
- Anna Durbin
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (R.W.); (M.D.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Correspondence: ; Tel.: +1-416-824-1078
| | - Bennett T. Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Stephen Abrams
- Cliffcrest Dental Office, Four Cell Consulting, Quantum Dental Technologies, Toronto, ON M6B 1L3, Canada;
| | - Andreas Mandelis
- Center for Diffusion-Wave and Photoacoustic Technologies (CADIPT), University of Toronto, Toronto, ON M5T 1R8, Canada; (A.M.); (K.S.)
| | - Sara Werb
- Toronto Children’s Dentistry, Toronto, ON M5T 1R8, Canada;
| | - Benjamin Roebuck
- Victimology Research Centre, Algonquin College, Ottawa, ON K2G 1V8, Canada;
| | - Janet Durbin
- Provincial System Support Program (PSSP), Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada;
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (R.W.); (M.D.)
| | - Maryam Daneshvarfard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (R.W.); (M.D.)
| | - Konesh Sivagurunathan
- Center for Diffusion-Wave and Photoacoustic Technologies (CADIPT), University of Toronto, Toronto, ON M5T 1R8, Canada; (A.M.); (K.S.)
| | - Laurent Bozec
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada;
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Kuhlman KR, Straka K, Mousavi Z, Tran ML, Rodgers E. Predictors of Adolescent Resilience During the COVID-19 Pandemic: Cognitive Reappraisal and Humor. J Adolesc Health 2021; 69:729-736. [PMID: 34384704 PMCID: PMC8460169 DOI: 10.1016/j.jadohealth.2021.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The COVID-19 pandemic and efforts to slow the spread of disease have particularly affected the lives of adolescents. Many studies have recently identified the risks to adolescent mental health posed by the COVID-19 pandemic, yet few have identified the markers of resilience to the events and concerns associated with the pandemic's lived experience. This study examined the moderating role of psychosocial resources in the association between the tangible and emotional experiences of the COVID-19 pandemic and symptoms of common psychiatric problems during adolescence (depression, anxiety, proactive and reactive aggression, and sleep problems). METHODS Participants were adolescents in the United States who were oversampled for early life adversity before the COVID-19 pandemic. The psychosocial resources assessed were humor styles, emotion regulation, social support, optimism, and purpose in life, which have previously been identified as protective in the acute aftermath of stressful events. RESULTS Greater COVID-19 impact was associated with more anxiety, depressive symptoms, sleep disturbance, and proactive aggression. COVID-19 impact and psychiatric symptoms were unrelated among youth reporting high self-enhancing humor and cognitive reappraisal. CONCLUSIONS Adolescents high in humor and cognitive reappraisal may be protected against the mental health correlates of the COVID-19 pandemic and other prolonged stressors. Importantly, these factors are known to be modifiable through behavioral interventions. Attention to their effectiveness in prevention and intervention studies is needed as the pandemic continues to exert its impact on individuals and society.
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Affiliation(s)
- Kate R. Kuhlman
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California,Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California Irvine, Irvine, California,Address correspondence to: Kate R. Kuhlman, University of California, 4201 Social & Behavioral Sciences Gateway, Irvine, CA 92697-7085
| | - Kelci Straka
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Zahra Mousavi
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Mai-Lan Tran
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Emma Rodgers
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
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Assessing Cardiometabolic Health Risk Among U.S. Children Living in Grandparent-Headed Households. J Pediatr Nurs 2021; 61:331-339. [PMID: 34543828 DOI: 10.1016/j.pedn.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE We evaluated children's cardiometabolic health (CMH) risk indicators and adverse childhood experiences (ACEs) stratified by family structure type (grandparent-headed, two-parent headed, and single-parent headed households). Separately, we assessed whether family structure type and number of ACEs were independently associated with the CMH risk indicators. DESIGN AND METHODS Utilizing data from the 2017-2018 National Survey of Children's Health, we evaluated five CMH risk indicators (obesity, physical activity, secondhand smoke exposure, sleep, and sports participation). We used multivariable logistic regressions to assess the association of CMH risk indicators with family structure type and ACEs. We controlled for sex, age, race/ethnicity, health insurance, household poverty level, and overall health status. RESULTS Among children aged 10-17 years (n = 24,885), we found the number of ACEs differed by family structure type (P < 0.001) and was independently associated with obesity, secondhand smoke exposure, sleep, and sports participation. Adjusting for all covariates except ACEs, family structure type was significantly associated with children's CMH risk; but after controlling for ACEs that association was attenuated - except for sleep (less adequate sleep in grandparent-headed households) and exposure to secondhand smoke (less exposure in single-parent headed households). CONCLUSIONS ACEs were highest among children living in grandparent-headed households and independently associated with a majority of the CMH risk indicators. Findings suggest that children living in grandparent-headed households may be at elevated risk for poor CMH, potentially due to higher risk for ACEs. PRACTICE IMPLICATIONS It is recommended to consider ACEs and family structure type when assessing CMH risk in children.
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Gordon JB. The importance of child abuse and neglect in adult medicine. Pharmacol Biochem Behav 2021; 211:173268. [PMID: 34499948 DOI: 10.1016/j.pbb.2021.173268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 01/21/2023]
Abstract
The risk for adverse consequences and disease due to the trauma of child abuse or neglect is easily assessed using the self-administered modified ACEs questionnaire. Exposure to child maltreatment is endemic and common. At least one out of every ten USA adults has a significant history of childhood maltreatment. This is a review of the literature documenting that a past history of childhood abuse and neglect (CAN) makes substantial contributions to physical disease in adults, including asthma, chronic obstructive pulmonary disease, lung cancer, hypertension, stroke, kidney disease, hepatitis, obesity, diabetes, coronary artery disease, pelvic pain, endometriosis, chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, and auto immune diseases. Adults who have experienced child maltreatment have a shortened life expectancy. The contribution of CAN trauma to these many pathologies remains largely underappreciated and neglected compared to the attention given to the array of mental illnesses associated with child maltreatment. Specific pathophysiolologic pathways have yet to be defined. Clinical recognition of the impact of past CAN trauma will contribute to the healing process in any disease but identifying specific effective therapies based on this insight remains to be accomplished. Recommendations are made for managing these patients in the clinic. It is important to incorporate screening for CAN throughout adult medical practice now.
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Affiliation(s)
- Jeoffry B Gordon
- California Citizens Review Panel on Critical Incidents, 2225 Louella Ave., Venice, CA 90291, United States.
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44
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Rodriguez CM. Talking to Parents about Spanking: The Potential for Pediatricians to Reduce the Impact of Adverse Childhood Experiences. J Pediatr 2021; 235:22-23. [PMID: 33684395 DOI: 10.1016/j.jpeds.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
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