Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention

Childhood maltreatment associated with adolescent peer networks: Withdrawal, avoidance, and fragmentation

BACKGROUND

Childhood maltreatment can affect subsequent social relationships, including different facets of peer relationships. Yet, how prior maltreatment shapes adolescents' connections within school peer networks is unclear, despite the rich literature showing the importance of this structural aspect of social integration in adolescence.

OBJECTIVES

This study examines how childhood physical abuse, emotional abuse, sexual abuse, and physical neglect predict adolescent social network structure as withdrawal, avoidance, and fragmentation among peers.

PARTICIPANTS AND SETTING

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves I, III, and IV yield a sample of 9154 respondents with valid network data and survey of childhood maltreatment.

METHODS

Models using linear regression examine childhood maltreatment predicting withdrawal, avoidance, and fragmentation in adolescent peer networks. Maltreatment is first measured as ever occurring, then separately by maltreatment type.

RESULTS

Results indicate that experiencing any maltreatment leads to withdrawal (lower sociality, B = -0.214, p = 0.008), avoidance (lower popularity, B = -0.222, p = 0.007), and fragmentation (lower cohesion, B = -0.009, p < 0.001). However, different types of maltreatment are associated with different dimensions of peer networks, with only physical neglect impacting all three dimensions.

CONCLUSIONS

Experiencing any maltreatment in childhood predicts lower integration in the adolescent peer network structure across three dimensions. However, distinct types of maltreatment relate differently to separate network dimensions, with sexual abuse predicting withdrawal, emotional and physical abuse predicting avoidance and fragmentation, and physical neglect predicting lower integration on all three dimensions.

Impact of Adverse Childhood Experiences in Young Adults and Adults: A Systematic Literature Review

BACKGROUND

Investigations have shown the different impacts that ACEs have on an individual's adult life, on both physical and mental health, but they have not yet shown the issue of the influence of ACEs on adults and young adults. Objective/Participants and Setting: This systematic review, performed according to the PRISMA norms and guidelines, intended to understand the most frequent outcomes of adverse childhood experiences in the life of young adults and adults.

METHODS

Studies were identified through multiple literature search databases at EBSCOhost, Web of Science, and PubMed April 2023, and a total of 279 studies, published between 1999 and 2002, were excluded, 256 because of multiple factors: being duplicates, showing statistical analysis with correlations only, being systematic reviews or case studies, comprising individuals under the age of 18, and not meeting the intended theme; ultimately, we selected for the review a total of 23 studies.

RESULTS AND CONCLUSIONS

The impacts of the various articles are subdivided into three main themes: antisocial and criminal behaviour; sexual Behaviour and intimate partner violence; and attachment, quality of life, and therapeutic alliance.

A Short Adverse Experiences Measure Among Mothers of Young Children

OBJECTIVES

Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department.

METHODS

From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression.

RESULTS

Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes.

CONCLUSIONS

A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.

Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs

This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.

"I have a special prayer 'O Lord, open my lips'": Experiences of ultra-Orthodox educators after their students' disclosures of sexual abuse

BACKGROUND

Child sexual abuse (CSA) is a large-scale, worldwide phenomenon. However, research on educators' experiences with CSA in specific social, cultural or religious contexts is limited.

OBJECTIVE

The current study is part of a larger qualitative research project examining Israeli educators' coping with CSA of their students in diverse cultural contexts. This study focused on Jewish ultra-Orthodox educators' perceptions and experiences of CSA disclosure and its impact on their professional and personal lives. Their perceptions of belonging to the ultra-Orthodox community were also explored.

METHODS

Interviews were conducted with 28 ultra-Orthodox educators and analyzed using a thematic approach.

RESULTS

The ultra-Orthodox educators perceived their roles on a continuum, from not being responsible to being fully responsible. They perceived the abused children as having negative behavior or as victims who deserved protection. Their personal lives were deeply affected, impacted by fear, disassociation or devotion to the mission of caring for these children. Finally, educators perceived the ultra-Orthodox community as fragile regarding CSA disclosure and emphasized the importance of encouraging culturally adaptive ways to conceptualize and address CSA.

CONCLUSIONS

This study highlights the importance of ultra-Orthodox educators in identifying CSA and leading interventions. It also raises the need for training to combine reflective, cultural-based practice and support for the educator to maintain their wellbeing. Despite this community's uniqueness, the current findings may be relevant to professionals and policymakers regarding other closed and religious communities and diverse educational settings confronting CSA.

The Influence of Adverse Childhood Experiences on Malevolent Creativity in Young Adulthood

BACKGROUND

Childhood trauma may increase the risk of antisocial behavior in young adulthood. Our study examined the relationship between Adverse Childhood Experiences (ACEs) and the specific antisocial behavior of malevolent creativity (MC), the application of original ideas to purposely harm others, often to gain an unfair advantage through manipulation, threat, or harm.

METHODS

We surveyed college students (N = 524; 78% women) on demographics, ACEs, empathy, social support, coping, general creativity, and malevolent creativity. The data were analyzed via sequential linear regression models.

RESULTS

Reporting ≥ 4 ACEs was associated with increased MC, which remained significant when general creativity and demographics were controlled. The association between higher ACEs and MC was no longer significant when psychosocial control variables (social support, empathy, and coping) were included in the statistical model. Social support and empathy were negatively associated with MC, while coping and MC were positively associated.

CONCLUSIONS

ACEs may increase the likelihood of malevolent creativity in young adulthood, but empathy and social support may disrupt this trajectory. Care should be taken that coping skills, while typically viewed as a positive addition to one's behavioral repertoire, do not push individuals toward over-reliance on themselves, which may reduce prosocial behaviors and increase MC.

Newspaper Coverage of Adverse Childhood Experiences and Toxic Stress in the United States, 2014-2020: Consequences, Causes, and Solutions

News media can shape public opinion about child adversity and influence the translation of research into public policy. Research about adverse childhood experiences (ACEs) and toxic stress has increased dramatically in recent years, but little is known about how these concepts are covered in news media. We reviewed how newspapers in the United States have portrayed the consequences of, causes of, and solutions to address ACEs and toxic stress, examined trends in newspaper coverage, and assessed differences in coverage of ACEs versus toxic stress. Quantitative content analysis was conducted of 746 newspaper articles mentioning "adverse childhood experience(s)" and/or "toxic stress" published in 25 U.S. newspapers between January 1, 2014, and May 30, 2020. κ statistics of interrater reliability were calculated, and variables with κ ≥ .60 were retained for quantitative analysis. We found that newspaper coverage of ACEs and toxic stress increased dramatically between 2014 and 2018 and then sharply declined. Only 13.3% of articles mentioned both ACEs and toxic stress. There were many statistically significant (p < .05) differences in the causes, consequences, and solutions identified in articles focused on ACEs versus toxic stress. Coverage of both concepts predominantly focused on consequences for individuals, not society. However, 54.6% of articles identified a structural cause of ACEs and/or toxic stress. Increased volume in newspaper coverage about ACEs and toxic stress could increase public awareness about the relationship between childhood adversity and adult outcomes. There is a need to portray ACEs and toxic stress as complementary concepts more coherently in news media.

Unintended consequences of disseminating behavioral health evidence to policymakers: Results from a survey-based experiment

Background

Communication research demonstrates that messages often have unintended consequences, but this work has received limited attention in implementation science. This dissemination experiment sought to determine whether state-tailored policy briefs about the behavioral health consequences of adverse childhood experiences (ACEs), compared to national policy briefs on the topic, increased state legislators'/staffers' perceptions of the policy brief relevance and parental blame for the consequences of ACEs, and whether effects differed between Democrats and Republicans.

Method

A preregistered, web-based survey experiment with U.S. state legislators/staffers was conducted in 2021 (n  =  133). Respondents were randomized to view a policy brief about the behavioral health consequences of ACEs that included state-tailored data (intervention condition) or national data (control condition) and then answered survey questions. Dependent variables were perceived policy brief relevance and parental blame for the consequences of ACEs.

Results

The mean policy brief relevance score was 4.1% higher in the intervention than in the control condition (p  =  .24), but the mean parental blame score was 16.5% higher (p  =  .02). When outcomes were dichotomized, 61.2% of respondents in the intervention condition rated parents as "very much to blame" for the consequences of ACEs compared to 37.1% in the control condition (p  =  .01). When the sample was stratified by political affiliation, the effect of the state-tailored policy brief on parental blame was larger in magnitude among Democrats and not significant among Republicans. The intervention policy brief increased the mean parental blame score by 22.8% among Democrats relative to the control policy brief (p  =  .007) and doubled the proportion rating parents as "very much to blame" (52.2% vs. 26.1%, p  =  .03).

Conclusions

Despite limited statistical power, state-tailored policy briefs significantly increased state legislators'/staffers' perceptions of parental blame for the behavioral health consequences of ACEs, relative to a policy brief with national data. Unintended messaging effects warrant greater attention in dissemination research and practice.

Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial

BACKGROUND

State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health.

METHODS

A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts.

RESULTS

For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts.

CONCLUSIONS

Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.

Childhood Experiences and Psychological Distress: Can Benevolent Childhood Experiences Counteract the Negative Effects of Adverse Childhood Experiences?

Background

Childhood experiences can exert a huge impact on adult psychological conditions. Previous studies have confirmed the effects of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) on psychological distress (e.g., stress, depression, and suicidal ideation) separately, but few studies explored a combined effect of ACEs and BCEs on psychological distress. The aim of this study was to explore a combined effect of ACEs and BCEs on psychological distress among Chinese undergraduates.

Methods

Participants were undergraduates aged 17–24 years (N = 1,816) and completed a self-reported questionnaire. A series of regression analyses were conducted to examine the association between childhood experiences and psychological distress.

Results

A total of 65.7% of undergraduates had BCEs, 27.1% of undergraduates had ACEs, and 12.9% of undergraduates had ACEs and BCEs simultaneously. Logistic regression analysis indicated that undergraduates who experienced high ACEs were more likely to have a high risk of psychological distress [odds ratio (ORs) = 1.46, 1.84, and 3.15 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively], while undergraduates who experienced High BCEs were less likely to have psychological distress (ORs = 0.33, 0.22, and 0.32 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively) compared with Low-Both group. The combined effect of ACEs and BCEs (High-Both group) could also play as a protective factor in uncertainty stress (OR = 0.56) and depressive symptoms (OR = 0.47).

Conclusion

Our findings suggested that ACEs and BCEs could not only predict the psychological distress independently, but also BCEs could counteract the negative effect of ACEs in psychological problems. There is an even greater need to identify and support the victims of ACEs and to increase BCEs in early childhood.

Selecting evidence to frame the consequences of adverse childhood experiences: testing effects on public support for policy action, multi-sector responsibility, and stigma

While clinical and public health researchers have produced a high volume of research evidence about the consequences of ACEs, there is limited research on public understanding of ACEs or how to most effectively communicate about this body of science. The objective of this study was to determine which messages describing evidence about the consequences of adverse childhood experiences (ACEs) affect public perceptions. We conducted an online experiment with a nationally-representative sample of U.S. adults in July-August 2020. Participants were randomized to control groups receiving messages describing ACE prevalence or resilience, or treatment groups receiving messages describing consequences of ACEs on mental health and substance use, economics, racial equity, or biology. We compared respondents' perceptions of prevention policies and likelihood of policy engagement, attributions of multi-sector responsibility, and blame and stigma across experimental groups. Messages about economic consequences increased respondents' support for policy and attributions of multi-sector responsibility relative to control groups, while also increasing parental blame. The message describing racial equity lowered respondents' perceptions of importance of state policy action and attributions of responsibility to health care. None of the messages affected stigmatizing attitudes. Describing the economic consequences of ACEs on public systems boosts public support for policy action. More research is needed on how the public responds to messaging connecting systemic racism with childhood adversity and health.