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Assaf RR, Assaf RD, Padlipsky PS, Young KDA. A family-centered approach to social needs awareness in the pediatric emergency department. PEC INNOVATION 2024; 4:100283. [PMID: 38689830 PMCID: PMC11059452 DOI: 10.1016/j.pecinn.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Objective We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital Orange County, Orange, USA
- Department of Pediatrics, University of California, Irvine (UCI) School of Medicine, Irvine, USA
| | - Ryan David Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Patricia Sencer Padlipsky
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
| | - Kelly Dee Ann Young
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
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Gannon M, Short V, Keith S, Hand D, Oliner LO, Yang A, Haerizadeh-Yazdi N, Ize-Iyamu A, Kelly E, Weinstein L, Goyal N, Jeminiwa R, Abatemarco D. Scarce perinatal social support for women with OUD: Opportunities for doula services. Midwifery 2024; 138:104169. [PMID: 39217911 DOI: 10.1016/j.midw.2024.104169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
PROBLEM Persons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes. BACKGROUND In the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled. QUESTION This study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas. METHODS This mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys -demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale- and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate. FINDINGS Participants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports. DISCUSSION The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad. CONCLUSION Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use.
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Affiliation(s)
- Meghan Gannon
- Thomas Jefferson University, Jefferson College of Nursing, Philadelphia, PA, USA.
| | - Vanessa Short
- Thomas Jefferson University, Jefferson College of Nursing, Philadelphia, PA, USA
| | - Scott Keith
- Thomas Jefferson University, Department of Biostatistics, Philadelphia, PA, USA
| | - Dennis Hand
- Thomas Jefferson University, Jefferson College of Nursing, Philadelphia, PA, USA
| | - Leah Owen Oliner
- Thomas Jefferson University, Sidney Kimmel Medical School, Philadelphia, PA, USA
| | - Angela Yang
- Thomas Jefferson University, Sidney Kimmel Medical School, Philadelphia, PA, USA
| | | | - Aisosa Ize-Iyamu
- Thomas Jefferson University, Sidney Kimmel Medical School, Philadelphia, PA, USA
| | - Erin Kelly
- Thomas Jefferson University, Department of Community and Family Medicine, Philadelphia, PA, USA
| | - Lara Weinstein
- Thomas Jefferson University, Department of Community and Family Medicine, Philadelphia, PA, USA
| | - Neera Goyal
- Nemours Childrens Health, Department of Pediatrics, Philadelphia, PA, USA
| | - Ruth Jeminiwa
- Thomas Jefferson University, Department of Pharmacy, Philadelphia, PA, USA
| | - Diane Abatemarco
- Thomas Jefferson University, Jefferson College of Nursing, Philadelphia, PA, USA
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Puosi E, Karlsson H, Lukkarinen H, Karlsson L, Lukkarinen M. Paternal adverse childhood experiences are associated with a low risk of atopy in the offspring. Acta Paediatr 2024; 113:2438-2451. [PMID: 38992923 DOI: 10.1111/apa.17345] [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: 02/16/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIM Parental adverse childhood experiences (ACE) might affect the offspring health through intergenerational inheritance. The aim of this study was to investigate how paternal ACE associate with offspring sensitisation and allergic rhinitis (AR). METHODS The study included 590 Finnish father-child dyads from the FinnBrain Birth Cohort Study. Outcomes were offspring sensitisation against allergens and AR at age 5.5 years. Paternal ACE up to 18 years were assessed using the Trauma and Distress Scale (TADS) with the lowest quarter as the reference group. RESULTS Of the children, 317 (54%) were males. Sensitisation occurred in 162/533 (30%) and AR in 122/590 (21%). Paternal TADS (median 17 points; interquartile range 11-27) was inversely associated with the risk of sensitisation. Children whose fathers scored the highest quarter had the lowest risk of sensitisation (adjusted odds ratio 0.42; 95% confidence interval 0.24-0.75), followed by those in the second highest quarter (0.58; 0.34-0.99). The association between the highest quarter and reduced risk of AR was similar. CONCLUSION Paternal ACE were associated with a low risk of offspring sensitisation and AR, suggesting paternal childhood stress might influence immune responses in their offspring.
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Affiliation(s)
- Emma Puosi
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku and Tyks Psychiatry, Turku University Hospital, Turku, Finland
| | - Heikki Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Tyks Department of Paediatrics and Adolescent Medicine, Turku University Hospital and Paediatrics and Adolescent Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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Pan Z, Chapman DA, Sullivan TN, Bishop DL, Kimmel AD. Healthy Communities for Youth: A Cost Analysis of a Community-Level Program to Prevent Youth Violence. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01729-z. [PMID: 39347995 DOI: 10.1007/s11121-024-01729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
Youth violence is a national public health concern in USA, especially in resource-constrained urban communities. Between 2018 and 2021, the Healthy Communities for Youth (HCFY) program addressed youth violence prevention in select economically marginalized urban communities, with the HCFY program reducing the likelihood of youth-involved violent crime. Leveraging costs from program expense reports, this study analyzes the costs of the HCFY program in order to inform policymaking and the program's future ongoing implementation. Total HCFY program costs were $821,000 ($290,100 annually including program start-up costs) over the 34-month project period. Operationalization costs contributed the largest share (64.8%), with 45% attributable to intervention coordinators. In the intervention community, the program costs $100 per capita, $1100 per youth-involved crime case, and $8100 per youth-involved violent crime case. Findings were sensitive to the number of youth-involved crime or violent crime cases and costs of high-level program leadership and self-evaluation analysts, with the per youth-involved violent crime case cost ranging between $700 and $1600 over the program period. Analysis of HCFY program costs is an important step in determining the affordability of a community-level program to prevent youth violence in resource-limited urban communities.
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Affiliation(s)
- Zhongzhe Pan
- School of Public Health, Department of Health Policy, Virginia Commonwealth University, Richmond, VA, USA.
| | - Derek A Chapman
- Center On Society and Health, Virginia Commonwealth University, Richmond, VA, USA
- School of Public Health, Department of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Terri N Sullivan
- Clark Hill Institute for Positive Youth Development, Virginia Commonwealth University, Richmond, VA, USA
- College of Humanities and Sciences, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Diane L Bishop
- Center On Society and Health, Virginia Commonwealth University, Richmond, VA, USA
- School of Public Health, Department of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
- Clark Hill Institute for Positive Youth Development, Virginia Commonwealth University, Richmond, VA, USA
| | - April D Kimmel
- School of Public Health, Department of Health Policy, Virginia Commonwealth University, Richmond, VA, USA.
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Li R, Xiao W, Wu J, Zhou Y, Zha J, Wang D, Xing T, Wan Y. Patterns of maternal adverse childhood experiences and the intergenerational association of preschool children's emotional and behavioral problems. Front Psychiatry 2024; 15:1431475. [PMID: 39193581 PMCID: PMC11347350 DOI: 10.3389/fpsyt.2024.1431475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction Children of whose mothers exposed to adverse childhood experiences (ACEs) are at increased risk for developmental problems. This study aims to investigate the relationship between types and patterns of maternal ACEs and preschool children's emotional and behavioral problems (EBPs) in China, and to explore gender differences associated with these problems. Methods In this cross-sectional study, we selected 9,647 children from 36 preschools in three cities of Anhui province, China. Questionnaires were used to report the details of maternal ACEs and children's EBPs. We used the latent class analysis (LCA) to identify "patterns" in the types of maternal ACEs. Binomial logistic regressions was performed to examine the relationship between types and patterns of maternal ACEs and preschoolers' EBPs. Results Latent class analysis (LCA) revealed four different classes of maternal ACEs. Logistic regression analysis showed that compared with the low ACEs class, children of mothers in the high abuse and neglect class had the highest risk of developing EBPs (OR = 5.93, 95%CI: 4.70-7.49), followed by moderate ACEs class (OR = 2.44, 95%CI: 1.98-3.00), and high household dysfunction class (OR = 2.16, 95%CI: 1.19-3.90). We found gender differences in the effects of high abuse and neglect/moderate ACEs class and maternal childhood physical abuse/neglect on children's EBPs, which had a stronger impact on EBPs in boys than girls (P<0.05). Discussion This study supports and refines existing research that confirms an intergenerational association between types and patterns of maternal ACEs and children's EBPs in a large Chinese sample, so as to provide references for the early prevention and control of children's EBPs.
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Affiliation(s)
- Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jun Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yang Zhou
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jinhong Zha
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Danni Wang
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tian Xing
- Key Laboratory of Oral Disease Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Li R, Jia L, Zha J, Wang X, Huang Y, Tao X, Wan Y. Association of maternal and paternal adverse childhood experiences with emotional and behavioral problems among preschool children. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02542-3. [PMID: 39126496 DOI: 10.1007/s00787-024-02542-3] [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: 10/25/2023] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Although maternal adverse childhood experiences (ACEs) are known to be related to the emotional and behavioral problems (EBPs) of offspring, few studies have surveyed the intergenerational effects of paternal ACEs. In addition, no study has yet explored the combination and interaction effects of maternal and paternal ACEs on preschool children's EBPs in China, and the gender differences in these relationships also remain to be explored. A total of 3,575 preschool children from 12 preschools from Hefei city of Anhui province were included in this study. We used a binomial logistic regression to examine the relationship between maternal ACEs, paternal ACEs and children's EBPs. Logistic regression analysis indicated that maternal and paternal ACEs were significantly related to EBPs in children, respectively. The high maternal ACEs + high paternal ACEs group had the greatest association with children's EBPs. Interaction analysis results showed that, compared with the reference group (low maternal ACEs×low paternal ACEs), the other group (high maternal ACEs×high paternal ACEs ) were significantly related to children's EBPs (OR = 1.84, 95%CI: 1.55-2.19). We found that there were no gender differences in the combination and interaction effects (P>0.05). When fathers and mothers were jointly exposed to high levels of ACEs, children had a higher risk of developing EBPs than when they were exposed independently. Future studies should fully explore the intergenerational health effects of parental ACEs so that references for promoting the physical and mental health of preschool children can be developed.
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Affiliation(s)
- Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Liyuan Jia
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Jinhong Zha
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Xiaoyan Wang
- Hefei Women and Children Medical Care Center, Hefei, China
| | - Yongling Huang
- Anhui Women and Children Medical Care Center, Hefei, China
| | - Xingyong Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China.
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China.
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Condon EM, Scheibner HR, Kuzel M, Howard M, Cisse M, O'Connell M, Conley Y, Jeon S, Sadler LS, Redeker NS. The CARING study: Examining biological, behavioral, and genetic mechanisms in the intergenerational transmission of toxic stress. Res Nurs Health 2024; 47:369-383. [PMID: 38804202 PMCID: PMC11236528 DOI: 10.1002/nur.22400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
When children experience extreme or persistent stressors (e.g., maltreatment, housing insecurity, intimate partner violence), prolonged elevation of the stress-response system can lead to disrupted development of multiple physiological systems. This response, known as toxic stress, is associated with poor physical and mental health across the life course. Emerging evidence suggests that the effects of toxic stress may be transmitted through generations, but the biological and behavioral mechanisms that link caregivers' childhood history with the health of the children they care for remain poorly understood. The purpose of this report is to describe the research protocol for The CARING (Childhood Adversity and Resilience In the Next Generation) Study, a cross-sectional study of caregivers with children aged 3-5 years designed to (1) examine the intergenerational transmission of toxic stress and protective factors; (2) explore three hypothesized pathways of transmission: parenting, daily routines, stressors, and supports; and (3) explore the extent to which genotypic variation in candidate genes related to caregiving and stress contribute to caregivers' and children's susceptibility to the effects of early childhood experiences (i.e., gene × environment interactions). We expect that findings from this study will provide critical data needed to identify targets for precision health interventions, reduce health disparities related to toxic stress, and prevent cycles of adversity among families at risk.
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Affiliation(s)
- Eileen M Condon
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | | | - Meredith Kuzel
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Mackenzie Howard
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Mouhamadou Cisse
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Meghan O'Connell
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Yvette Conley
- University of Pittsburg School of Nursing, Pittsburg, Pennsylvania, USA
| | | | | | - Nancy S Redeker
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Jia H, Lubetkin EI. Ranking the Ten Adverse Childhood Experiences: Long-Term Consequences to Health-Related Quality of Life. Am J Prev Med 2024; 67:265-273. [PMID: 38599501 DOI: 10.1016/j.amepre.2024.04.001] [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: 11/15/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION This study compared the long-term harmful consequences of individual adverse childhood experiences (ACEs) to subsequent health-related quality of life (HRQOL) among U.S. adults. METHODS Respondents were from the eleven U.S. states that included the optional ACE module questionnaire in the 2021 Behavioral Risk Factor Surveillance Systems (BRFSS). Relative importance (RI) was estimated for ten ACEs to respondents' self-rated general health (SRGH), physically unhealthy days (PUD), mentally unhealthy days (MUD), and activity limitation days (ALD). A variable's importance was measured as the average gains in R-squared after adding the variable to all sub-models. Statistical analysis was performed in 2023. RESULTS After controlling for demographics, household mental illness was the most important ACE for SRGH, MUD, and ALD, with RIs of 16.4, 28.4 and 23.4, respectively. This ACE was ranked second for PUD (RI=17.8). Sexual abuse was ranked first for PUD (18.7), second for MUD (16.6) and ALD (20.9), and fifth for SRGH (10.4). Parental separation (RI ≤2.4) and incarcerated household member (2.8-5.4) were the least important ACEs for all 4 outcomes. Sexual abuse, parental separation, emotional abuse, and basic needs were not met were considerably more important among females while household mental illness and household substance abuse were more important among males. CONCLUSIONS This study highlight that certain ACEs play a greater role than others for HRQOL with certain ACEs having a greater relative importance according to sex. Additionally, a significant proportion of the long-term impacts of ACE to HRQOL was indirectly through the mediation effect of other explanatory variables.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, New York.
| | - Erica I Lubetkin
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York
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Perrins SP, Vermes E, Cincotta K, Xu Y, Godoy-Garraza L, Chen MS, Addison R, Douglas B, Yatco A, Idaikkadar N, Willis LA. Understanding forms of childhood adversities and associations with adult health outcomes: A regression tree analysis. CHILD ABUSE & NEGLECT 2024; 153:106844. [PMID: 38761717 DOI: 10.1016/j.chiabu.2024.106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Empirical studies have demonstrated associations between ten original adverse childhood experiences (ACEs) and multiple health outcomes. Identifying expanded ACEs can capture the burden of other childhood adversities that may have important health implications. OBJECTIVE We sought to identify childhood adversities that warrant consideration as expanded ACEs. We hypothesized that experiencing expanded and original ACEs would be associated with poorer adult health outcomes compared to experiencing original ACEs alone. PARTICIPANTS The 11,545 respondents of the National Longitudinal Surveys (NLS) and Child and Young Adult Survey were 48.9 % female, 22.7 % Black, 15.8 % Hispanic, 36.1 % White, 1.7 % Asian/Native Hawaiian/Pacific Islander/Native American/Native Alaskan, and 7.5 % Other. METHODS This study used regression trees and generalized linear models to identify if/which expanded ACEs interacted with original ACEs in association with six health outcomes. RESULTS Four expanded ACEs-basic needs instability, lack of parental love and affection, community stressors, and mother's experience with physical abuse during childhood -significantly interacted with general health, depressive symptom severity, anxiety symptom severity, and violent crime victimization in adulthood (all p-values <0.005). Basic needs instability and/or lack of parental love and affection emerged as correlates across multiple outcomes. Experiencing lack of parental love and affection and original ACEs was associated with greater anxiety symptoms (p = 0.022). CONCLUSIONS This is the first study to use supervised machine learning to investigate interaction effects among original ACEs and expanded ACEs. Two expanded ACEs emerged as predictors for three adult health outcomes and warrant further consideration in ACEs assessments.
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Affiliation(s)
| | - Ellen Vermes
- ICF, 1902 ICF Reston Plaza, Reston, VA 20190, USA
| | | | - Ye Xu
- ICF, 1902 ICF Reston Plaza, Reston, VA 20190, USA
| | | | - May S Chen
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway NE, Mailstop S106-10, Atlanta, GA 30341-3717, USA
| | - Ronnesha Addison
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Highway NE, Mailstop S106-8, Atlanta, GA 30341-3717, USA
| | - Brooke Douglas
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway NE, Mailstop S106-10, Atlanta, GA 30341-3717, USA
| | - Allison Yatco
- Oak Ridge Institute for Science and Education, 100 ORAU Way, Oak Ridge, TN 37830, USA
| | - Nimi Idaikkadar
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Highway NE, Mailstop S106-8, Atlanta, GA 30341-3717, USA
| | - Leigh A Willis
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway NE, Mailstop S106-10, Atlanta, GA 30341-3717, USA
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10
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Barcelona V, Condon EM, Jacoby SF. Leveraging biosocial methods to examine and address structural determinants of health and promote health equity. Nurs Outlook 2024; 72:102195. [PMID: 38810533 PMCID: PMC11330731 DOI: 10.1016/j.outlook.2024.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions. PURPOSE Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities. METHODS This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods." DISCUSSION Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities. CONCLUSION Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, CT; Department of Pediatrics, University of Connecticut School of Medicine, Storrs, CT
| | - Sara F Jacoby
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA
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Williams HN, Farley B. Trauma-informed care. Semin Pediatr Neurol 2024; 50:101139. [PMID: 38964815 DOI: 10.1016/j.spen.2024.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024]
Abstract
In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.
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Affiliation(s)
- Heather N Williams
- Director-SAFEchild Advocacy Center, Medical Director-Child Maltreatment Team, WakeMed Children's Hospital, Raleigh, NC, USA.
| | - Brenna Farley
- Program Manager-SAFEchild Advocacy Center, Raleigh, NC, USA
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12
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Naseh M, Zeng Y, Ahn E, Cohen F, Rfat M. Mental Health Implications of Family Separation Associated with Migration Policies in the United States: A Systematic Review. Soc Sci Med 2024; 352:116995. [PMID: 38810506 DOI: 10.1016/j.socscimed.2024.116995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/13/2023] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
The practice of family separation as a mechanism of oppression has a deep-rooted history in the U.S., manifesting in diverse contexts, including punitive migration policies. This systematic review aimed to provide a rigorous and updated synthesis of the research on family separation as a result of migration policies and its impacts on immigrants' mental health while making a distinction between forced family separation, family separation by constrained choices, and living with the fear of family separation. We systematically searched four bibliographic databases using keywords related to family separation, migration, transnational families, and mental health for peer-reviewed studies published in English on or before January 1st, 2022. Results of the review indicate that family separation or fear of it may result in depression, anxiety, behavioral and emotional issues, sleep disturbances, and stress or distress in affected children. Similarly, impacted parents or caregivers might experience stress or distress, depression, anxiety, and sleep disturbances. Findings call for migration policy changes prioritizing family unity and comprehensive mental health interventions to respond to the pervasive consequences of family separation or fear thereof among immigrants in the U.S.
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Affiliation(s)
- Mitra Naseh
- Brown School, Washington University in St. Louis, St. Louis, 1 Brookings Dr, MO, 63130, USA.
| | - Yingying Zeng
- School of Social Work, University of Georgia, Athens, GA, USA.
| | - Eunhye Ahn
- Brown School, Washington University in St. Louis, St. Louis, 1 Brookings Dr, MO, 63130, USA.
| | - Flora Cohen
- School of Social Work, University of Illinois Urbana-Champaign, IL, USA
| | - Mustafa Rfat
- Brown School, Washington University in St. Louis, St. Louis, 1 Brookings Dr, MO, 63130, USA
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13
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Zhu Y, Zhang G, Zhan S, Jiao D, Anme T. Do multigenerational homes moderate the intergenerational transmission of maternal adverse childhood experiences? Eur J Psychotraumatol 2024; 15:2355757. [PMID: 38809612 PMCID: PMC11138223 DOI: 10.1080/20008066.2024.2355757] [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: 09/27/2023] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACTBackground: Maternal adverse childhood experiences (ACEs) may lead to increased behavioural problems in children. However, the mediating roles of psychological distress and corporal punishment, two common mechanisms underlying the intergenerational transmission of maternal ACEs, in these relations have not been examined in Chinese samples. Multigenerational homes (MGH) are the dominate living arrangement in China; however, limited research focuses on the effects of MGHs on the intergenerational transmission of maternal ACEs.Objective: This study explored the parallel mediating effects of corporal punishment and psychological distress on the association between maternal ACEs and children's behaviour and whether MGHs can strengthen or weaken the relationship between maternal ACEs and corporal punishment or psychological distress.Participants and setting: Participants were 643 three-year-old children and their mothers (mean age of 32.85 years, SD = 3.79) from Wuhu, China.Methods: Mothers completed online questionnaires measuring ACEs, psychological distress, corporal punishment, their family structure, and children's behavioural problems. This study used a moderated mediation model.Results: The findings suggest that psychological distress and corporal punishment mediate the association between maternal ACEs and children's behavioural problems. The mediating role of corporal punishment was found depend on whether mothers and their children reside in MGHs. MGHs were not found to have a moderating role in the indirect relationship between maternal ACEs and children's behaviour problems via psychological distress.Conclusion: Our findings highlight the importance of addressing psychological distress and corporal punishment when designing interventions targeted Chinese mothers exposed to ACEs and their children, especially those living in MGHs.
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Affiliation(s)
- Yantong Zhu
- Faculty of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China
| | - Gengli Zhang
- Faculty of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China
| | - Shuwei Zhan
- School of Education, Central China Normal University, Wuhan, People’s Republic of China
| | - Dandan Jiao
- Department of Nursing, First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, People’s Republic of China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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14
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Hornor G. Child Sexual Abuse Victimization and Parenting. J Pediatr Health Care 2024; 38:438-449. [PMID: 38697699 DOI: 10.1016/j.pedhc.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 05/05/2024]
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15
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Bilmez Selen M, Demir P, Eden E, Inceoğlu F. Relationship between parental adverse childhood experiences and the prevalence of early childhood caries. Clin Oral Investig 2024; 28:243. [PMID: 38580751 DOI: 10.1007/s00784-024-05635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES The aim of this study was to examine the behavioural health conditions associated with parents' retrospective adverse childhood experiences (ACEs) scores and their children's early childhood caries (ECC) in parent-child dyads. MATERIALS AND METHODS Parents with children younger than 72 months were included in the study. A relational screening model was used. Interaction among ACEs, ECC, nutritional habits and oral hygiene habits were evaluated. Chi-square tests and t-tests were used in the study. Multiple variables were evaluated using the artificial neural network (ANN) model. RESULTS The mean age of the 535 children included in the study was 46.5 months, and 52% were female. Using the ANN model, there was a statistically significant relationship between the educational status of the mothers in both the ECC and severe ECC (S-ECC) groups and the socioeconomic status of the family (p < 0.05). If the number of snacks consumed daily was three or more, the risk of ECC was statistically significantly higher (chi-square test p = 0.034). The parents' ACEs scores had an impact on both ECC and S-ECC formation (p = 0.001, t-test). The higher the ACEs score, the higher the risk of S-ECC. The mean ACEs scores of the parents were also significantly higher in both the ECC and S-ECC groups compared to those of the parents of children without dental caries (p = 0.001, t-test). It was calculated that ACEs scores were effective at a rate of 18.2% on ECC (p = 0.045, ANN). CONCLUSIONS The ACEs scores of parents have an impact on the oral health of young children and ECC/S-ECC formation. CLINICAL RELEVANCE The long-term effects of parental ACEs are reflected in their children's oral health. Therefore, reducing the psychosocial determinants ACEs and providing parental support may help in overcoming barriers to the well-being of young children and may facilitate better oral health.
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Affiliation(s)
| | - Pınar Demir
- Nuh Naci Yazgan University Faculty of Dentistry, Kayseri, Turkey
| | - Ece Eden
- Ege University Faculty of Dentistry, Izmir, Turkey
| | - Feyza Inceoğlu
- Malatya Turgut Ozal University Faculty of Medicine, Malatya, Turkey
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16
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Lê-Scherban F, Wang A, Courts KA, Ettinger de Cuba S, Wade R, Chilton M. A Short Adverse Experiences Measure Among Mothers of Young Children. Pediatrics 2024; 153:e2023063882. [PMID: 38449423 DOI: 10.1542/peds.2023-063882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department. METHODS From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression. RESULTS Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes. CONCLUSIONS A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics
- Drexel Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Anqi Wang
- Department of Epidemiology and Biostatistics
| | - Kelly A Courts
- Department of Epidemiology and Biostatistics
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Stephanie Ettinger de Cuba
- Boston University School of Public Health and Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Roy Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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17
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Grafft N, Lo B, Easton SD, Pineros-Leano M, Davison KK. Maternal and Paternal Adverse Childhood Experiences (ACEs) and Offspring Health and Wellbeing: A Scoping Review. Matern Child Health J 2024; 28:52-66. [PMID: 37914980 DOI: 10.1007/s10995-023-03825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common, often co-occur, and are associated with poor health outcomes across the life course. Emerging research has emphasized the lasting consequences of ACEs across generations, suggesting parental ACEs are associated with poor physical and mental health outcomes in children. However, the individual effects of fathers' ACEs and pathways of transmission remain unclear. A scoping review was conducted to summarize the current knowledgebase of the intergenerational consequences of parental ACEs on offspring health, clarify pathways of transmission, understand how ACEs are operationalized in the intergenerational literature, and identify gaps in knowledge. METHODS Six electronic databases were searched for articles published in English from 1995 to 2022 relating to the long-term consequences of parental ACEs on offspring physical and mental health. Articles underwent title, abstract, and full-text review by two investigators. Content analysis was performed to integrate findings across the included studies. RESULTS The search yielded 14,542 unique articles; 49 met the inclusion criteria. Thirty-six articles focused exclusively on mothers, one solely on fathers, and 12 included both mothers and fathers in their analyses. Six studies used an expanded definition of ACEs. Both direct and indirect associations between parental ACEs and poor offspring outcomes were identified, primarily through biological and psychosocial pathways. CONCLUSIONS Findings underscore the importance and oversight of fathers and the need to solidify a unified definition and measure of ACEs. This review identified modifiable protective factors (social support, father involvement) and pathways of transmission (parental mental health, parenting); both having important implications for intervention development.
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Affiliation(s)
- Natalie Grafft
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA.
| | - Brian Lo
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Scott D Easton
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Maria Pineros-Leano
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Kirsten K Davison
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
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18
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Toombs E, Lund J, Kushnier L, Stopa A, Wendt DC, Mushquash CJ. Addressing experiences of trauma within Indigenous-focused substance use residential treatment: a systematic review and environmental scan. J Ethn Subst Abuse 2023:1-53. [PMID: 38146766 DOI: 10.1080/15332640.2023.2293943] [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: 12/27/2023]
Abstract
Indigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, ON, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | - Jessie Lund
- Department of Psychology, Lakehead University, ON, Canada
| | | | - Ana Stopa
- Department of Psychology, Lakehead University, ON, Canada
| | | | - Christopher J Mushquash
- Department of Psychology, Lakehead University, ON, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
- Thunder Bay Regional Health Sciences Centre, ON, Canada
- Thunder Bay Regional Health Research Institute, ON, Canada
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19
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Xiao Y, Mann JJ, Chow JCC, Brown TT, Snowden LR, Yip PSF, Tsai AC, Hou Y, Pathak J, Wang F, Su C. Patterns of Social Determinants of Health and Child Mental Health, Cognition, and Physical Health. JAMA Pediatr 2023; 177:1294-1305. [PMID: 37843837 PMCID: PMC10580157 DOI: 10.1001/jamapediatrics.2023.4218] [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: 07/10/2023] [Accepted: 08/20/2023] [Indexed: 10/17/2023]
Abstract
Importance Social determinants of health (SDOH) influence child health. However, most previous studies have used individual, small-set, or cherry-picked SDOH variables without examining unbiased computed SDOH patterns from high-dimensional SDOH factors to investigate associations with child mental health, cognition, and physical health. Objective To identify SDOH patterns and estimate their associations with children's mental, cognitive, and physical developmental outcomes. Design, Setting, and Participants This population-based cohort study included children aged 9 to 10 years at baseline and their caregivers enrolled in the Adolescent Brain Cognitive Development (ABCD) Study between 2016 and 2021. The ABCD Study includes 21 sites across 17 states. Exposures Eighty-four neighborhood-level, geocoded variables spanning 7 domains of SDOH, including bias, education, physical and health infrastructure, natural environment, socioeconomic status, social context, and crime and drugs, were studied. Hierarchical agglomerative clustering was used to identify SDOH patterns. Main Outcomes and Measures Associations of SDOH and child mental health (internalizing and externalizing behaviors) and suicidal behaviors, cognitive function (performance, reading skills), and physical health (body mass index, exercise, sleep disorder) were estimated using mixed-effects linear and logistic regression models. Results Among 10 504 children (baseline median [SD] age, 9.9 [0.6] years; 5510 boys [52.5%] and 4994 girls [47.5%]; 229 Asian [2.2%], 1468 Black [14.0%], 2128 Hispanic [20.3%], 5565 White [53.0%], and 1108 multiracial [10.5%]), 4 SDOH patterns were identified: pattern 1, affluence (4078 children [38.8%]); pattern 2, high-stigma environment (2661 children [25.3%]); pattern 3, high socioeconomic deprivation (2653 children [25.3%]); and pattern 4, high crime and drug sales, low education, and high population density (1112 children [10.6%]). The SDOH patterns were distinctly associated with child health outcomes. Children exposed to socioeconomic deprivation (SDOH pattern 3) showed the worst health profiles, manifesting more internalizing (β = 0.75; 95% CI, 0.14-1.37) and externalizing (β = 1.43; 95% CI, 0.83-2.02) mental health problems, lower cognitive performance, and adverse physical health. Conclusions This study shows that an unbiased quantitative analysis of multidimensional SDOH can permit the determination of how SDOH patterns are associated with child developmental outcomes. Children exposed to socioeconomic deprivation showed the worst outcomes relative to other SDOH categories. These findings suggest the need to determine whether improvement in socioeconomic conditions can enhance child developmental outcomes.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - J. John Mann
- Departments of Psychiatry and Radiology, Columbia University Irving Medical Center, Columbia University, New York, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
| | | | | | | | - Paul Siu-Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Hong Kong, China
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Yu Hou
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Chang Su
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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20
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Duka S, Rahman S, Hansen SE, Esernio-Jenssen D. The Effect of Maternal Adverse Childhood Experiences (ACEs) on Substance Use During Pregnancy. Matern Child Health J 2023; 27:153-165. [PMID: 37733152 PMCID: PMC10691987 DOI: 10.1007/s10995-023-03768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To analyze adverse childhood experiences (ACEs) among mothers of newborns referred to a hospital's child protection team (CPT) for suspected substance exposure. Researchers hypothesized that a higher prevalence of these mothers have ≥ 4 ACEs than female counterparts in the general population. The study team also explored whether associations existed between type of maternal ACEs and substance use in pregnancy. METHODS Retrospective review of infant referrals to the CPT in the 3 years after adding an ACEs questionnaire to the consultation process. Bivariate analyses and multivariate logistic regression models examined associations between prenatal substance use and maternal ACEs prevalence, controlling for demographics. RESULTS Data from 222 infants (four sets of twins) and 218 mothers were analyzed. Half (50.0%) the infants had withdrawal symptoms. Most (67.0%) women had positive toxicology screens, while 85.0% reported prenatal substance use. Half (50.9%) the mothers reported ≥ 4 ACEs and these individuals had significantly higher odds of cannabinoid use [adjusted odds ratio (aOR), 3.7; 95%CI 2.0, 6.9, p < 0.001) than those with < 4 ACEs. A significant association was found between substance use and ACEs in the household challenges category (p = 0.03), especially parental separation/divorce (p < 0.001). CONCLUSIONS FOR PRACTICE As hypothesized, a higher prevalence of mothers referred to the CPT had ≥ 4 ACEs than women in the general population (50.9% vs. 15.2%), and a large proportion had used substances while pregnant. Routine prenatal ACEs screening and universal, nonpunitive toxicology testing of infants and mothers at birth may provide opportunities for intervention while reducing the transgenerational impact of ACEs.
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Affiliation(s)
- Shae Duka
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, USA
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Sadeea Rahman
- Department of Pediatrics, Jacobi Medical Center, New York, USA
| | - Susan E Hansen
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, USA
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Debra Esernio-Jenssen
- Morsani College of Medicine, University of South Florida, Tampa, USA.
- Department of Pediatrics, Lehigh Valley Health Network, Allentown, USA.
- Lehigh Valley Reilly Children's Hospital, Cedar Crest Boulevard and I-78, Allentown, PA, 18103, USA.
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21
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Pryce P, Gangopadhyay M, Edwards JD. Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents. Pediatr Crit Care Med 2023; 24:1022-1032. [PMID: 37615404 DOI: 10.1097/pcc.0000000000003339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children. DESIGN Single-center prospective observational study. SETTING Urban academic children's hospital from January to December 2021. PATIENTS One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18). CONCLUSIONS ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
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Affiliation(s)
- Patrice Pryce
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maalobeeka Gangopadhyay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jeffrey D Edwards
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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22
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Zhang L, Mersky JP, Gruber AMH, Kim JY. Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3251-3264. [PMID: 36205317 DOI: 10.1177/15248380221126186] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.
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23
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Flagg AM, Lin B, Crnic KA, Gonzales NA, Luecken LJ. Intergenerational Consequences of Maternal Childhood Maltreatment on Infant Health Concerns. Matern Child Health J 2023; 27:1981-1989. [PMID: 37294466 DOI: 10.1007/s10995-023-03717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Childhood maltreatment is a well-established risk factor for health problems in adulthood and may also have intergenerational consequences for infant health. Childhood maltreatment may confer risk for infant health by undermining caregiver capacities for sensitive and responsive caregiving. However, associations among childhood maltreatment, maternal sensitivity, and infant health are not well understood. These processes may be of particular importance among low-income and ethnic minority populations for whom disparities in maltreatment exposure and poorer health outcomes are well-established. METHOD The current study drew data from a sample of low-income, Mexican American families to examine whether maternal childhood maltreatment would be associated with more infant health concerns, and whether lower maternal sensitivity would explain their associations. Data were collected from 322 mother-infant dyads during home visits completed during pregnancy and when infants were 12, 18, and 24 weeks old. RESULTS Maternal childhood maltreatment exposure and lower maternal sensitivity were both associated with more infant health concerns. Maternal childhood maltreatment was not associated with maternal sensitivity. DISCUSSION These findings highlight potential intergenerational consequences of maternal childhood maltreatment for infant health and underscore a need for evaluating pre- and postnatal mechanisms through which these effects may be perpetuated. Furthermore, results indicate that maternal sensitivity may represent a promising target for interventions seeking to counteract intergenerational transmission processes. Clarification about underlying risk processes and potentiating resiliency characteristics may elucidate ways to better support mothers and infants across the lifespan.
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Affiliation(s)
- Amanda M Flagg
- Department of Psychology, University at Albany, State University at New York, Albany, NY, USA.
| | - Betty Lin
- Department of Psychology, University at Albany, State University at New York, Albany, NY, USA
| | - Keith A Crnic
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Nancy A Gonzales
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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Barnert ES, Schlichte LM, Tolliver DG, La Charite J, Biely C, Dudovitz R, Leifheit K, Russ S, Sastry N, Yama C, Slavich GM, Schickedanz A. Parents' Adverse and Positive Childhood Experiences and Offspring Involvement With the Criminal Legal System. JAMA Netw Open 2023; 6:e2339648. [PMID: 37878312 PMCID: PMC10600584 DOI: 10.1001/jamanetworkopen.2023.39648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
Importance Intergenerational cycles of adversity likely increase one's risk of criminal legal system involvement, yet associations with potential contributors, such as parents' adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), have not been explored. Objective To investigate the association of parents' ACEs and PCEs with their adult children's involvement in US legal systems, from arrest to conviction. Design, Setting, and Participants The study team analyzed data from the Panel Study of Income Dynamics (PSID), a nationally representative cohort study of families in the US. PSID-2013 survey data were merged with the 2014 PSID Childhood Retrospective Circumstances Study (CRCS), collected May 2014 to January 2015, which asked adults aged 18 to 97 years to retrospectively report on their childhood experiences. Parents and their adult children were linked in the data set. Data were analyzed from October 2022 to September 2023. Main Outcomes and Measures The child arrest outcome was regressed on parents' ACE and PCE scores using logistic regression models. In addition, multinomial logistic regression models were used to assess the associations of parents' ACE and PCE scores with the number of times their child was arrested and convicted. Results Of 12 985 eligible individuals, 8072 completed the CRCS. Among CRCS participants, there were 1854 eligible parent-child dyads (ie, parents and their adult children) that formed the analytic sample. The mean (SD) age of offspring at the time of CRCS completion was 38.5 (10.9) years, and 1076 offspring (51.3%) were female. Having 4 or more parental ACEs was associated with 1.91-fold (95% CI, 1.14-3.22) higher adjusted odds of arrest before age 26 and 3.22-fold (95% CI, 1.62-6.40) higher adjusted odds of conviction before age 26 years, compared with children of parents without ACEs. These associations persisted after controlling for parental PCEs. Conclusions and Relevance In this nationally representative study, children of parents with higher ACEs were at greater risk of arrest during adolescence and young adulthood, even after controlling for parents' PCEs. Addressing and preventing childhood adversity through multigenerational life course approaches may help disrupt intergenerational pathways to the criminal legal system.
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Affiliation(s)
- Elizabeth S. Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lindsay M. Schlichte
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
- Duke University School of Medicine, Durham, North Carolina
| | - Destiny G. Tolliver
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jaime La Charite
- Department of General Internal Medicine at UCLA, Los Angeles, California
| | - Christopher Biely
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kathryn Leifheit
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shirley Russ
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Narayan Sastry
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Cecile Yama
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles
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25
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Santos M, Burton ET, Cadieux A, Gaffka B, Shaffer L, Cook JL, Tucker JM. Adverse childhood experiences, health behaviors, and associations with obesity among youth in the United States. Behav Med 2023; 49:381-391. [PMID: 35792894 DOI: 10.1080/08964289.2022.2077294] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/13/2022] [Accepted: 05/04/2022] [Indexed: 11/02/2022]
Abstract
Adverse Childhood Experiences (ACEs) affect almost half of youth in the U.S. and are linked to a host of deleterious medical and psychosocial outcomes. The current study examines the relationships among ACEs, childhood obesity, and modifiable lifestyle behaviors to inform clinical care, future research, and policy. Using data from the 2016-2018 National Survey of Children's Health (NSCH), associations between children's ACEs, weight status, and health behaviors that may influence the link between ACEs and obesity were examined. In the NSCH data, 25.3% of youth aged 10-17 years experienced one ACE with another 25.9% experiencing two or more ACEs. Having ACEs was related to excess screen time and inadequate sleep, and independently associated with obesity. Findings highlight the importance of providers screening and finding ways to intervene on behalf of youth with obesity. The present provides guidelines for providers on intervening with youth experiencing ACEs.
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Affiliation(s)
- Melissa Santos
- The Pediatric Obesity Center, Connecticut Children's, Hartford, CT, USA
| | - E Thomaseo Burton
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science, Memphis, TN, USA
| | - Adelle Cadieux
- 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
| | - Bethany Gaffka
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, TN, 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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26
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Williams RC. Des expériences négatives de l'enfance à la santé relationnelle précoce : les conséquences pour la pratique clinique. Paediatr Child Health 2023; 28:377-393. [PMID: 37744761 PMCID: PMC10517240 DOI: 10.1093/pch/pxad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Les enfants grandissent et se développent dans un environnement de relations. Des relations sécuritaires, stables et bienveillantes contribuent à consolider la résilience et à atténuer les répercussions des expériences négatives. La promotion de la santé relationnelle en pratique clinique recentre l'attention accordée aux expériences négatives de l'enfance sur les expériences positives de l'enfance. Cette approche, qui évalue les forces et les atouts d'une famille, peut être intégrée à la fois aux rendez-vous réguliers de l'enfant en santé et aux soins surspécialisés. Il est optimal de réaliser de telles interventions pendant la période prénatale ou le plus rapidement possible avant l'âge de trois ans, mais il n'est jamais trop tard pour les entreprendre. Le présent document de principes décrit comment les cliniciens peuvent adopter une approche de santé relationnelle lors de chacune de leurs rencontres médicales s'ils comprennent ce qu'est le stress toxique et ses effets sur le cerveau en développement, les relations familiales et le développement de l'enfant; à quel point les relations, expériences et comportements positifs peuvent en atténuer les effets et renforcer la résilience; quels sont les signes observables de la santé relationnelle et des risques relationnels dans les interactions entre les parents et l'enfant; quelles sont les caractéristiques de relations thérapeutiques de confiance avec les familles et comment en optimiser les avantages par les échanges et la pratique clinique.
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Affiliation(s)
- Robin C Williams
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario), Canada
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27
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Williams RC. From ACEs to early relational health: Implications for clinical practice. Paediatr Child Health 2023; 28:377-393. [PMID: 37744756 PMCID: PMC10517248 DOI: 10.1093/pch/pxad025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Children grow and develop in an environment of relationships. Safe, stable, nurturing relationships help build resilience and buffer the negative impact of adverse experiences. Promoting relational health in clinical practice shifts the focus from adverse childhood experiences (ACEs) to positive childhood experiences (PCEs). This approach evaluates a family's strengths and assets, and can be incorporated into both well-child and subspecialty care. While the optimal window for such interventions is in the prenatal period or as early as possible within the first 3 years of life, it is never too late to start. This statement describes how clinicians can bring a relational health approach to any medical encounter by understanding: what toxic stress is and how it can affect the developing brain, family relationships, and child development; how positive relationships, experiences, and behaviours can help buffer such effects and build resilience; observable signs of relational health and risk in parent-child interactions; the attributes of trustful, therapeutic relationships with families; and how to optimize these benefits through conversation and clinical practice.
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Affiliation(s)
- Robin C Williams
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario, Canada
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28
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Mamun A, Biswas T, Scott J, Sly PD, McIntyre HD, Thorpe K, Boyle FM, Dekker MN, Doi S, Mitchell M, McNeil K, Kothari A, Hardiman L, Callaway LK. Adverse childhood experiences, the risk of pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2023; 13:e063826. [PMID: 37536966 PMCID: PMC10401231 DOI: 10.1136/bmjopen-2022-063826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood. OBJECTIVE To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes. SEARCH STRATEGY A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022. DATA COLLECTION AND ANALYSIS Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I2 statistics. RESULTS 32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71). CONCLUSION The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.
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Affiliation(s)
- Abdullah Mamun
- UQ Poche Centre for Indigenous Health, University of Queensland, Saint Lucia, Queensland, Australia
| | - Tuhin Biswas
- University of Queensland, Brisbane, Queensland, Australia
| | - James Scott
- University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Queensland Childrens Medical Research Instit, University of Queensland, Herston, Queensland, Australia
| | - H David McIntyre
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Karen Thorpe
- University of Queensland, Brisbane, Queensland, Australia
| | | | - Marloes N Dekker
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Suhail Doi
- Population Medicine, Qatar University, Doha, Ad Dawhah, Qatar
| | - Murray Mitchell
- Faculty of Health, School of Biomedical Sciences, QUT, Brisbane, Queensland, Australia
| | - Keith McNeil
- Queensland Health, Brisbane, Queensland, Australia
| | - Alka Kothari
- University of Queensland, Brisbane, Queensland, Australia
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29
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Foti TR, Watson C, Adams SR, Rios N, Staunton M, Wei J, Sterling SA, Ridout KK, Young-Wolff KC. Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6289. [PMID: 37444136 PMCID: PMC10341286 DOI: 10.3390/ijerph20136289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by resilience. The sample comprised pregnant patients in two pilot studies screened for eight ACEs and resilience during standard prenatal care in Kaiser Permanente Northern California from 1 March 2016 to 30 July 2016 (Study 1, medical centers A, B) and from 1 April 2018 to 31 March 2019 (Study 2, medical centers A, C). Early pregnancy outcomes included anxiety and depressive disorders, depression symptoms, intimate partner violence (IPV), and substance use. Multivariable logistic regression was used in this cross-sectional study to examine associations between maternal ACEs (0, 1-2, ≥3) and mental/behavioral health outcomes overall and among those with low and high resilience. Patients (n = 1084) averaged 30.8 years (SD 5.1); 41.7% were non-Hispanic White; 41.7% experienced ≥1 ACE, and 40.3% had low resilience. Patients with 1-2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use (OR 1.44-4.40, p < 0.05). Each individual ACE was associated with ≥2 mental/behavioral health outcomes. In stratified analyses, having ≥1 ACE (vs. 0) was associated with a greater number of mental/behavioral health outcomes among patients with low versus high resilience. ACEs were associated with prenatal mental/behavioral health conditions, particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.
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Affiliation(s)
- Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Carey Watson
- Obstetrics and Gynecology, Kaiser Permanente, Antioch Medical Center, Antioch, CA 94531, USA
| | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Normelena Rios
- Obstetrics and Gynecology, Kaiser Permanente, Dublin Medical Center, Dublin, CA 94568, USA
| | - Mary Staunton
- Department of Psychiatry, Kaiser Permanente, Walnut Creek Medical Center, Walnut Creek, CA 94596, USA
| | - Julia Wei
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kathryn K. Ridout
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry, Kaiser Permanente, Santa Rosa Medical Center, Santa Rosa, CA 95403, USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
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30
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Sweeting JA, Akinyemi AA, Holman EA. Parental Preconception Adversity and Offspring Health in African Americans: A Systematic Review of Intergenerational Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:1677-1692. [PMID: 35240883 DOI: 10.1177/15248380221074320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background: This systematic review explores the empirical literature addressing the association between parental preconception adversity and offspring physical health in African-American families. Method: We conducted a literature search in PubMed, Web of Science, PsycINFO, CINAHL, and Scopus through June 2021. Articles were included if they: reported data about at least two generations of African-American participants from the same family; measured parental preconception adversity at the individual level; measured at least one offspring physical health outcome; and examined associations between parental adversity and child health. Results: We identified 701 unique articles; thirty-eight articles representing 30 independent studies met inclusion criteria. Twenty-five studies (83%) reported that parental preconception adversity was associated with child health; six studies (20%) reported that parental preconception adversity was not associated with at least one offspring outcome; several studies reported both. Only six studies (20%) reported an association specific to African Americans. Conclusion: Empirical evidence linking parental preconception adversity with offspring physical health in African Americans is limited and mixed. In the current literature, very few studies report evidence addressing intergenerational associations between parental preconception adversity and offspring physical health in the African-American population, specifically, and even fewer investigate forms of parental preconception adversity that have been shown to disproportionately affect African Americans (e.g., racism). To better understand root causes of racial health disparities, more rigorous systematic research is needed to address how intergenerational transmission of historical and ongoing race-based trauma may impact offspring health among African Americans.
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Affiliation(s)
- Josiah A Sweeting
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Adebisi A Akinyemi
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Ellen Alison Holman
- Department of Psychological Science, University of California, Irvine, CA, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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31
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Hartwell M, Hendrix-Dicken A, Terry R, Schiffmacher S, Conway L, Croff JM. Trends and forecasted rates of adverse childhood experiences among adults in the United States: an analysis of the Behavioral Risk Factor Surveillance System. J Osteopath Med 2023; 123:357-363. [PMID: 36947857 DOI: 10.1515/jom-2022-0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
CONTEXT Many studies have shown increases in negative social aspects in the United States that may increase the likelihood of a child experiencing adversity. These rising trends include household dysfunction, poor mental health and substance use, crime rates, and incarceration. Additionally, the pathway of adverse childhood experiences (ACEs) may also perpetuate intergenerational trauma. OBJECTIVES Given these increased trends, our objective was to determine the mean ACEs reported among adults by year of birth to assess trends of ACEs over time. METHODS To assess ACEs trends in the United States, we utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey. We summed individuals' reported ACEs and then calculated the mean ACE score within age cohorts (in 1-year increments) by year of birth. We utilized an auto-regressive integrated moving average (ARIMA) model to forecast mean ACEs through 2030. RESULTS Respondents to the ACEs module (n=116,378) represented 63,076,717 adults in the United States, with an average age cohort of 1715 individuals. The mean reported ACEs among individuals 80 years or older (born in or before 1940) was 0.79, while the highest mean ACEs (2.74) were reported among the cohort born in 1998-an average increase of 0.022 ACEs per year. The ARIMA model forecasted that individuals born in 2018 will, on average, surpass a cumulative of three ACEs. CONCLUSIONS Given the connection of ACEs to poor health outcomes and quality of life, this trend is alarming and provides evidence for the necessity of child maltreatment prevention. Multigenerational trauma-informed care and education are warranted for individuals with ACEs and may even prevent the cycle from recurring.
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Affiliation(s)
- Micah Hartwell
- Department of Psychiatry and Behavioural Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
| | - Amy Hendrix-Dicken
- Department of Paediatrics, University of Oklahoma, School of Community Medicine, Tulsa, OK, USA
| | - Rachel Terry
- Oklahoma State University College of Osteopathic Medicine, Office of Medical Student Research, Tulsa, OK, USA
| | - Sadie Schiffmacher
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
| | - Lauren Conway
- Department of Paediatrics, University of Oklahoma, School of Community Medicine, Tulsa, OK, USA
| | - Julie M Croff
- Oklahoma State University Centre for Health Sciences, National Centre for Wellness and Recovery, Tulsa, OK, USA
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32
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Arnold R, Ahmed F, Clarke A, Quinn N, Beenstock J, Holland P. The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review. Public Health 2023; 219:146-153. [PMID: 37186980 DOI: 10.1016/j.puhe.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES A growing body of research is emerging regarding the relationship between parental adverse childhood experiences (ACEs) and negative health, well-being and developmental outcomes in their children. This systematic review seeks to understand the relationship between parental ACEs and the health, well-being and developmental outcomes of their children and whether the relationships differ according to the number and type of parental ACEs. STUDY DESIGN Systematic review. METHOD The review includes articles published between 2000 and 2021 from studies using quantitative longitudinal methods and multivariate analysis to investigate the relationship between parental ACEs and their offspring's outcomes. Relevant studies were identified through a systematic search of five databases and findings synthesised using a narrative synthesis. This review was registered on PROSPERO (CRD42021274068). RESULTS Nineteen studies met the inclusion criteria and were included in the review. This resulted in a combined population sample of 124,043 parents and 128,400 children. Diversity in measurement of parental ACE exposure and in the type of ACEs measured within the studies precluded a meta-analysis. Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs, with a positive relationship observed between the number of parental ACEs and the risk of negative health, well-being and development outcomes in their children. CONCLUSIONS These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.
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Affiliation(s)
- R Arnold
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, England, UK.
| | - F Ahmed
- Division of Health Research, Lancaster University, UK
| | - A Clarke
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK; Save the Children UK, London, England, UK
| | - N Quinn
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - J Beenstock
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - P Holland
- Division of Health Research, Lancaster University, UK
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Yang Y, Cheng J, Liu P. Impacts on children's health of adverse childhood experiences of their mothers: A gender-specific mediation analysis using data from the China Health and Retirement Longitudinal Study. J Affect Disord 2023; 323:232-240. [PMID: 36455713 DOI: 10.1016/j.jad.2022.11.057] [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: 07/20/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Numerous people have suffered adverse childhood experiences (ACEs) that can have lasting negative consequences. However, few studies have focused on maternal ACEs' effect on their children's health. This study aimed to evaluate the impact on children's health of ACEs that their mothers experienced. METHODS Data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 combined with the CHARLS 2014 Life History Survey were analyzed. The logistic regression was used to investigate maternal ACEs' impact on their children's health. Based on the stepwise regression model and bias-corrected bootstrap, we estimated the mediating effects. RESULTS Maternal ACEs could result in harm to the health of children (P < 0.05). If the types of maternal ACEs increased by one unit, the odds ratio of their children's poor health would rise by 9.6 %. Moreover, if the types of maternal ACEs increased by one unit, the odds ratio of daughters' and sons' poor health would increase by 8.3 % and 10.2 %, respectively. Three mediating mechanisms of mothers' education, physical health, and mental health were confirmed by empirical tests. LIMITATIONS We could not employ objective indicators to measure children's health. Meanwhile, maternal ACEs were all self-reported from the mothers' recollection, which might descend the accuracy due to memory bias. CONCLUSION Maternal ACEs harmed the health of both their sons and daughters. The children's health would deteriorate as the maternal ACEs increased. Mother's education, physical health, and mental health mediated the relationships between maternal ACEs and children's health.
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Affiliation(s)
- Yuxuan Yang
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Jianxin Cheng
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, China
| | - Paicheng Liu
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
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Kapke TL, Karst J, LiaBraaten B, Zhang J, Yan K, Barbeau J, Hainsworth KR. Family Caregiver Acceptability of Assessing Caregiver Adverse Childhood Experiences (ACEs) and Distress in Pediatric Specialty Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:382. [PMID: 36832511 PMCID: PMC9954957 DOI: 10.3390/children10020382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Providing quality healthcare for children includes assessing and responding to needs of their family caregivers. Three salient domains to consider are caregivers' early adverse childhood experiences (ACEs), their current levels of distress, and their resilience in coping with both prior and current stressors. OBJECTIVE Determine acceptability of assessing caregiver ACEs, current distress, and resilience in pediatric subspecialty care settings. METHODS Caregivers of patients in two pediatric specialty care clinics completed questionnaires about their ACEs, recent emotional distress, and resilience. Importantly, caregivers also rated the acceptability of being asked these questions. Participants included 100 caregivers of youth ages 3-17 across Sickle Cell Disease and Pain clinic settings. The majority of participants were mothers (91.0%) who identified as non-Hispanic (86.0%). Caregiver race was primarily African American/Black (53.0%) and White (41.0%). The Area Deprivation Index (ADI) was used to assess socioeconomic disadvantage. RESULTS High levels of caregiver acceptability or neutrality with assessing ACEs and distress, as well as high ACEs, distress, and resilience. Associations were found between caregiver ratings of acceptability with caregiver resilience and socioeconomic disadvantage. Caregivers reported openness to being asked about their experiences during childhood and recent emotional distress, although ratings of acceptability varied according to other contextual variables, such as level of socioeconomic disadvantage and caregiver resilience. In general, caregivers perceived themselves to be resilient in the face of adversity. CONCLUSIONS Assessing caregiver ACEs and distress in a trauma-informed way may provide opportunities for better understanding the needs of caregivers and families in order to support them more effectively in the pediatric setting.
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Affiliation(s)
- Theresa L. Kapke
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Jane B. Pettit Pain and Headache Center, Children’s Wisconsin, Wauwatosa, WI 53226, USA
| | - Jeffrey Karst
- Division of Pediatric Psychology & Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- MACC Fund Center for Cancer and Blood Disorders, Children’s Wisconsin, Wauwatosa, WI 53226, USA
| | - Brynn LiaBraaten
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Jane B. Pettit Pain and Headache Center, Children’s Wisconsin, Wauwatosa, WI 53226, USA
| | - Jian Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ke Yan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jody Barbeau
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Keri R. Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Jane B. Pettit Pain and Headache Center, Children’s Wisconsin, Wauwatosa, WI 53226, USA
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Arowolo T, Animasahun A, Baptiste-Roberts K, Bronner Y. Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 17:1-10. [PMID: 36818743 PMCID: PMC9924853 DOI: 10.1007/s40653-023-00517-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Family responses to crises such as COVID-19 are driven by parents' experiences. Parental history of adverse childhood experiences (ACEs) might play an important role in predicting resilience, coping capacity, and parenting practices during the COVID-19 pandemic response. The purpose of this review is to examine the impact of COVID-19 pandemic disruption on child health and well-being as influenced by the previous history of ACEs in the parents. Scopus, Google Scholar, PubMed, and PsychInfo were searched for peer-reviewed articles using the keywords "COVID-19", "Parents or Maternal Adverse Childhood Experiences", and "child health" or "child well-being". Data were extracted using a literature review matrix template. Title, abstract, and full article-level reviews were conducted by two reviewers. The association between COVID-19 disruption, negative parenting, and child behavioral and emotional problems was stronger for parents with younger children with a history of high ACE scores. Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions. Trauma-informed care should be adopted to contribute to optimum child health.
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Affiliation(s)
- Tolu Arowolo
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Adeola Animasahun
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Kesha Baptiste-Roberts
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Yvonne Bronner
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
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Chen D, Lin L, Li C, Chen W, Zhang Y, Ren Y, Guo VY. Maternal adverse childhood experiences and health-related quality of life in preschool children: a cross-sectional study. Child Adolesc Psychiatry Ment Health 2023; 17:19. [PMID: 36747212 PMCID: PMC9903527 DOI: 10.1186/s13034-023-00570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The intergenerational association between maternal adverse childhood experiences (ACEs) and their children's health-related quality of life (HRQOL) is underexplored. This study aimed to examine such association in Chinese preschool children and to test the moderation role of children's sex. METHODS A cross-sectional study was conducted among 4243 mother-child dyads who attended randomly selected preschools. Mothers self-reported their experience of 12 forms of ACEs, including emotional abuse, physical abuse, emotional neglect, physical neglect, intimate partner violence, substance abuse in the household, incarcerated household member, mental illness in household, parental death, parental separation or divorce, bullying, and community violence. Children's HRQOL was evaluated through mother report of the Pediatric Quality of Life Inventory version 4.0. Linear regression models were established to estimate the associations between maternal ACEs and their children's HRQOL sub-scores and total scores. Stratified analysis and test for interaction were further conducted to evaluate whether the associations were moderated by children's sex. RESULTS Of the included mothers, 85.8% (n = 3641) had reported exposure to at least one ACE, and 22.3% (n = 948) were exposed to three or more ACEs. Compared to children of mothers without any ACE exposure, those of mothers with 1, 2, or ≥ 3 ACEs all had significantly lower scores of physical, social, and school functioning, as well as lower psychosocial health summary score and total scale score in both crude and adjusted models. However, only children of mothers with two or more ACEs had significantly poorer emotional functioning when compared to their counterparts whose mothers had no ACE exposure. A significant dose-response pattern was also observed between the number of maternal ACEs and children's HRQOL sub-scores and total scores. Stratified analysis revealed sex-specific pattern between maternal ACEs and their children's HRQOL. Nonetheless, children's sex was not a significant moderator. CONCLUSIONS Our study showed that preschool children of mothers who had any experience of ACEs were at risk of poorer HRQOL. Our findings indicated that screening maternal ACEs in young children and promoting targeted interventions might be a feasible way to mitigate or stop the potential negative intergenerational health and wellbeing implications of ACEs.
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Affiliation(s)
- Dezhong Chen
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Li Lin
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Chunrong Li
- grid.54549.390000 0004 0369 4060Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weiqing Chen
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Ren
- grid.54549.390000 0004 0369 4060Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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Bottaccioli AG, Bottaccioli F. Come gli stati psichici si traducono in molecole biologiche e come questo cambia la medicina e la psicologia. PSICOTERAPIA E SCIENZE UMANE 2023. [DOI: 10.3280/pu2023-001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Nell'aprile del 2022 abbiamo pubblicato, su invito di una rivista internazionale di biologia molecolare, un'ampia review che riporta le principali evidenze scientifiche sul tema delle relazioni tra vita psichica e biologia, traendone alcune conclusioni di carattere generale sulla psicologia e la medicina (Bottaccioli, Bologna & Bottaccioli, 2022). Il presente articolo riprende alcuni dei passaggi fondamentali presentati in quella review e si collega a un precedente articolo pubblicato sul n. 4/2014 di Psicoterapia e Scienze Umane (Bottaccioli, 2014b), di cui rappresenta un aggiornamento. Dalla pubblicazione di quell'articolo le evidenze sperimentali e cliniche sull'influenza della psiche sui sistemi biologici si sono moltiplicate. Al tempo stesso, conosciamo meglio le vie e i meccanismi con cui gli stati psichici si traducono in biologia.
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Buchanan GJR, Tate AD, Barnes A, Trofholz AC, Berge JM. Potential Points of Intervention to Minimize the Impact of Parents' Adverse Childhood Experiences on Child Mental Health. J Dev Behav Pediatr 2023; 44:e24-e31. [PMID: 36563343 PMCID: PMC9793946 DOI: 10.1097/dbp.0000000000001140] [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: 04/15/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Children of parents who experienced adverse childhood experiences (ACEs) are at elevated risk for mental health (MH) issues. The goal of this study was to explore the relationships between parent ACEs and child MH and to identify potential mediators and points of psychosocial intervention. METHODS Participants were 1307 children aged 5 to 9 years from diverse backgrounds and their primary caregivers. Using cross-sectional questionnaire data, we used structural equation modeling to examine the research questions. RESULTS Parent ACEs were directly related to child MH issues (β = 0.189, p < 0.001). This relationship was fully mediated by parent MH (β = 0.374, p < 0.001; β = 0.246, p < 0.001) and positive parenting behaviors (β = -0.237, p < 0.001; β = -0.556, p < 0.001). High parent ACEs were negatively associated with parent MH (β = 0.374, p < 0.001), which was then negatively associated with parenting behaviors (β = -0.500, p < 0.001), which was then negatively associated with child MH (β = -0.600, p < 0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (β = 0.102, p < 0.05). CONCLUSION Parents with high ACEs but who have good mental health and positive parenting behaviors demonstrated no impact of their ACEs on their children's mental health. Providing MH care to parents and parenting programs may be strategies for improving children's MH. Parenting behavior assessment is recommended for clinicians when pediatric patients present with MH concerns.
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Affiliation(s)
- Gretchen J. R. Buchanan
- Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis
| | - Allan D. Tate
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Andrew Barnes
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Amanda C. Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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Shih EW, Ahmad SI, Bush NR, Roubinov D, Tylavsky F, Graff C, Karr CJ, Sathyanarayana S, LeWinn KZ. A path model examination: maternal anxiety and parenting mediate the association between maternal adverse childhood experiences and children's internalizing behaviors. Psychol Med 2023; 53:112-122. [PMID: 34001294 PMCID: PMC9290334 DOI: 10.1017/s0033291721001203] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 03/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Children of mothers with adverse childhood experiences (ACEs) are at increased risk for developmental problems. However, the mechanisms through which a mother's experience of ACEs are transmitted to her offspring are understudied. The current study investigates potential modifiable mediators (maternal psychopathology and parenting) of the association between maternal ACEs and children's behavioral problems. METHODS We utilized data from a pregnancy cohort study (N = 1030; CANDLE study) to investigate longitudinal associations between maternal ACEs, postpartum anxiety, observed parenting behavior, and child internalizing behaviors (meanage = 4.31 years, s.d. age = 0.38) in a racially diverse (67% Black; 33% White/Other) sample. We used structural equation modeling to test for direct associations between maternal ACEs and children's internalizing behaviors, as well as indirect associations via two simple mediations (maternal anxiety and parenting), and one serial mediation (sequence of maternal anxiety to parenting). RESULTS Simple mediation results indicated that maternal anxiety and cognitive growth fostering behaviors independently mediated the association between maternal ACEs and child internalizing. We observed no evidence of a serial mediation from ACEs to internalizing via the effects of maternal anxiety on parenting. CONCLUSIONS This study supports and refines extant literature by confirming the intergenerational association between maternal ACEs and child internalizing behaviors in a large, diverse sample, and identifies potential modifiable mediators: maternal anxiety and parenting behaviors related to fostering cognitive development. Findings may inform interventions targeting mothers who have experienced ACEs and suggest that providing support around specific parenting behaviors and addressing maternal anxiety may reduce internalizing behaviors in children.
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Affiliation(s)
- Emily W. Shih
- University of California, San Francisco, San Francisco, CA, USA
| | - Shaikh I. Ahmad
- University of California, San Francisco, San Francisco, CA, USA
| | - Nicole R. Bush
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Sheela Sathyanarayana
- University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Kaja Z. LeWinn
- University of California, San Francisco, San Francisco, CA, USA
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Zhu Y, Zhang G, Anme T. Patterns of adverse childhood experiences among Chinese preschool parents and the intergenerational transmission of risk to offspring behavioural problems: moderating by coparenting quality. Eur J Psychotraumatol 2022; 13:2137913. [PMID: 36387949 PMCID: PMC9648376 DOI: 10.1080/20008066.2022.2137913] [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: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Although intergenerational transmission of ACEs among parents and their offspring have been extensively studied in the West, few studies have been conducted in China on preschool children and their parents, and explore the protective fact for the intergeneration transmission. Objective: Using latent class analysis and moderation model, this study examined the associations between patterns of adverse childhood experiences of Chinese preschool parents and behavioural problems in their children and whether coparenting quality plays a protective role in this relationship. Method: A retrospective study was conducted on 3091 parent-child dyads from 11 kindergartens in the northern, central, and southern Anhui provinces in China. Online questionnaires were used to collect the data. Parents reported adverse childhood experiences (ACEs) and provided information on their children's behavioural problems and perceived coparenting quality. Latent class analysis and a moderating model were used to examine the associations between patterns of adverse childhood experiences of Chinese preschool parents and behavioural problems in their children, and the moderating role of coparenting quality. Results: Four classes were identified: a high ACEs group, a violent victimisation group, a child abuse and physical neglect group, and a low ACEs group. Increasing levels of co-parenting quality were associated with reduced parent-reported child behaviour problems for all classes, and that potentially buffering effect was significantly stronger for the low ACEs class than for children whose parents in high ACEs class. Conclusions: Exposure to high ACEs increases the risk of developing behavioural problems in offspring, and coparenting quality may serve as a protective mechanism for intergenerational transmission. Future research should develop and implement interventions to support disadvantaged, at-risk parents and promote coparenting quality.
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Affiliation(s)
- Yantong Zhu
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Gengli Zhang
- Faculty of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Wang X, Yin G, Guo F, Hu H, Jiang Z, Li S, Shao Z, Wan Y. Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20311-NP20330. [PMID: 34652992 DOI: 10.1177/08862605211050093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45-3.45), and no gender difference (in girls 3.01, 2.38-3.81, in boys 2.79, 2.17-3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems.
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Affiliation(s)
- Xiaoyan Wang
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Gangzhu Yin
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Feng Guo
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Haili Hu
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Zhicheng Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Ziyu Shao
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
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DeCandia CJ, Volk KT, Unick GJ. Evolving Our Understanding: Housing Instability as an ACE for Young Children. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:365-380. [PMID: 36320362 PMCID: PMC9607722 DOI: 10.1007/s42844-022-00080-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
Abstract
We investigated the conceptualization and impact of adverse childhood experiences (ACEs) in a sample of 231 children ages 3-5 living in poverty and experiencing homelessness, focusing specifically on caregiver well-being and housing instability. Data was collected using the Neurodevelopmental Ecological Screening Tool (NEST), which screens for developmental risk and resilience across three domains (neurodevelopmental, caregiver, and environment). We used structural equation modelling (SEM) to test the association between domains and ACE scores and assessed the impact on neurodevelopmental constructs. Fifty-five percent of the sample had high ACE scores (> 3), which were associated with lower attention, social skills, and emotional regulation. ACEs were strongly associated with 0.17 standard deviation units of higher levels of caregiver distress (p < .001), which was also associated with 0.26 standard deviation units of lower levels of child neurodevelopmental functioning (p = .001). For each unit increase in housing instability, there was a three-fourths increase in ACE (0.78 ACE at p = .004); four or more moves were associated with the worst neurodevelopmental outcomes (53% of the sample). We must use an ecological, developmental lens to understand how early adversity impacts children, at what age, and in what context. Housing stability plays a critical role in developmental well-being and should be accounted for in conceptualizations of child ACE scales. Caregiver and child relationships are reciprocal, and so the impacts of ACEs are also bidirectional. Our policies and practices at individual, community, and systemic levels should account for these dynamics to improve child well-being.
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Affiliation(s)
| | | | - George J. Unick
- School of Social Work, University of Maryland, Baltimore, MD USA
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Lee J, Gao M, Lee C. Gendered racial disparities in health of parents with children with developmental disabilities. Front Psychol 2022; 13:926655. [PMID: 36118507 PMCID: PMC9479760 DOI: 10.3389/fpsyg.2022.926655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is little information on (1) how adverse experiences in early life are associated with the risk of having a child with health problems and (2) whether the health of racial and gender minority groups would be particularly compromised if they have developmentally disabled (DD) children. Objective By integrating life-course perspectives and the intersectionality framework, we examine (1) the extent to which parents’ early-life adversities (ELAs) are associated with having children with DD or other health issues and (2) whether the association between having DD children and parental (physical and mental) health varies across race–gender groups after accounting for ELAs. Methods Using data from Black and White parents from the Midlife in the US Study (n = 7,425; 18% Black), we employed (1) multinomial logistic regression models to investigate the degree to which ELAs are associated with parenting types (having a child with DD, a child with recent illness, or a child without these health issues) and (2) multiple regression models with a three-way interaction term to investigate whether the gender–parenting type association differs by race. Results With more adversities, the probability of having children with health issues increases for all race–gender groups, but most dramatically for Black women. Having DD children is associated with more chronic illnesses and functional limitations for women than men, with the largest burden for Black women, yet neither gender nor racial differences in depressive symptoms. Our results highlight that while raising children with DD takes a toll on the health of all parents, the strain might be larger for Black mothers. Conclusion The adverse effects of parenting a child with DD is more pronounced for Black women than for other race–gender groups indicating opportunities to promote community-based programs for these parents.
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Benzies KM, Perry R, Cope Williams J. Influence of the COVID-19 pandemic on executive skills in Canadians experiencing social vulnerability: A descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1853-e1861. [PMID: 34708472 PMCID: PMC8652764 DOI: 10.1111/hsc.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/25/2021] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to describe executive skills in clients experiencing social vulnerability in the context of COVID-19 from the perspective of social service agency staff. COVID-19 has required transformational changes to livelihood and day-to-day living. Socially vulnerable individuals are likely to be disproportionally impacted because many have experienced serious early childhood adversity, which may compromise their executive skills in adulthood. Using a cross-sectional survey, we collected data between 05 May 2020 and 03 July 2020, for this mixed methods study of 53 staff in two agencies in western Canada serving clients experiencing social vulnerability. The first case of COVID-19 in this jurisdiction was identified 05 March 2020. Using investigator-designed survey items, we captured executive skills in five areas: (a) planning tasks of daily living, (b) managing time, (c) keeping track of information and appointments, (d) managing emotions, and (e) managing self-control. Staff reported their clients struggled with executive skills and these struggles increased during COVID-19, particularly in the areas of managing daily tasks and emotional regulation. COVID-19 restrictions overwhelmed clients with the decisions required to maintain health, employment, and childcare. With the loss of structure and routine, clients lost track of time and delayed completion of tasks, which further increased stress. Disrupted goals and uncertainty about the future contributed to hopelessness for clients who were trying to regain control over their lives, which made it difficult to manage emotions. Some clients acted more impulsively because of the added stressors, lack of routine and access to friends and extended family. A better understanding of the impact of COVID-19 on socially vulnerable clients will inform social service agencies about areas to focus programming to support their socially vulnerable clients.
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Affiliation(s)
| | - Robert Perry
- CUPS (formerly Calgary Urban Project Society)CalgaryAlbertaCanada
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Toombs E, Lund J, Radford A, Drebit M, Bobinski T, Mushquash CJ. Adverse Childhood Experiences (ACEs) and Health Histories Among Clients in a First Nations-Led Treatment for Substance Use. Int J Ment Health Addict 2022:1-21. [PMID: 35937611 PMCID: PMC9341413 DOI: 10.1007/s11469-022-00883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Jessie Lund
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Abbey Radford
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Meagan Drebit
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
- Northern Ontario School of Medicine (NOSM), Lakehead University, Thunder Bay, ON Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON Canada
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON Canada
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Prentice DM, Otaibi BW, Stetter C, Kunselman AR, Ural SH. The Association Between Adverse Childhood Experiences and Postpartum Depression. Front Glob Womens Health 2022; 3:898765. [PMID: 35692946 PMCID: PMC9183059 DOI: 10.3389/fgwh.2022.898765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAdverse childhood experiences (ACEs) are linked to worsening overall health outcomes and psychological diagnoses. Routine screening, particularly in patients with postpartum depression (PPD), would identify patients who could benefit from interventions to prevent the perpetuation of ACEs and establish a system of preventative care to mitigate the risks of adverse health outcomes associated with high ACE scores. The purpose of this study is to explore the link between ACEs and PPD to advocate for the use of the ACE questionnaire as a routine screening tool in all pregnant patients diagnosed with PPD. We hypothesize that a cohort of patients with PPD will be more likely to have high-risk ACE scores than the general female population.Study DesignOur IRB approved, retrospective cohort study identified all patients diagnosed with PPD at an academic medical center between January 2015 and December 2019. The subjects were identified using retrospective chart review. Subjects were recruited via telephone and asked to complete an ACE questionnaire. Questionnaires were sent via RedCap. ACE scores were calculated, categorized as 0, 1, 2, 3, or 4 or more ACEs, and compared to the prevalence in the original Kaiser-CDC ACE study female cohort using a chi-square goodness-of-fit test.ResultsThere were 132/251 surveys completed (53% response rate). In our PPD population, 19.3% had 0 ACEs, 17.0% had 1 ACE, 13.1% had 2 ACEs, 16.5% had 3 ACEs, and 34.1% had 4 or more ACEs. These percentages were significantly different from the Kaiser-CDC ACE Study percentages of 34.5, 24.5, 15.5, 10.3, and 15.2%, respectively (p < 0.001).ConclusionOur unique study showed that women with PPD are more likely to have high-risk ACE scores than the general female population. This finding has important implications in regards to counseling, intervening to prevent perpetual ACEs, and establishing important provider-patient relationships for life-long preventative care.Non-gendered language is used when possible throughout. However, the wording from studies cited in this paper was preserved.
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Affiliation(s)
- Danielle M. Prentice
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
- *Correspondence: Danielle M. Prentice
| | | | - Christy Stetter
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, United States
| | - Allen R. Kunselman
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, United States
| | - Serdar H. Ural
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
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Doi S, Isumi A, Fujiwara T. Association between maternal adverse childhood experiences and child resilience and self-esteem: Results from the K-CHILD study. CHILD ABUSE & NEGLECT 2022; 127:105590. [PMID: 35287013 DOI: 10.1016/j.chiabu.2022.105590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Previous studies have found that children of mothers with adverse childhood experiences (ACEs) are more likely to have adverse mental health outcomes. However, little is known about the role of other cognitive abilities, such as resilience and self-esteem, in how children deal with stressful situations. OBJECTIVE To examine the association between maternal ACEs and resilience and self-esteem in children. PARTICIPANTS AND SETTING The data was collected as part of the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016. Participants included 2759 in first grade, 2878 in fifth grade, 3143 in eighth grade, and 3611 children in 11th grade living in Kochi Prefecture, Japan (N = 12,391). METHODS Maternal ACEs and covariates were reported by mothers. Mothers provided information regarding their children's resilience for children in the first, fifth, and eighth grades. Children in the fifth, eighth, and 11th grades reported their own self-esteem. RESULTS Children of mothers with a larger number of ACEs had lower levels of resilience (p for trend (i.e., linear associations) < 0.001) as well as lower levels of self-esteem (p for trend <0.001), adjusting for potential confounding variables. These associations became non-significant after adjusting for potential mediators, and the relationship was mediated by variables such as maternal psychological distress, current socioeconomic status, and parenting behaviors. CONCLUSIONS There was a significant dose-response relationship between the number of maternal ACEs and children's resilience and self-esteem, and this relationship may be mediated by maternal psychological distress, current socioeconomic status, and positive parenting behaviors. Further interventional studies that break the link between maternal ACEs and resilience and self-esteem should be conducted.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Bunting L, McCartan C, Davidson G, Grant A, Mulholland C, Schubotz D, McBride O, Murphy J, Nolan E, Shevlin M. Experiences of childhood adversity across generations - Continuity or change? A study from the Northern Ireland youth wellbeing survey. CHILD ABUSE & NEGLECT 2022; 127:105568. [PMID: 35247660 DOI: 10.1016/j.chiabu.2022.105568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking. OBJECTIVE This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads. PARTICIPANTS AND SETTING Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074). METHODS Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables. RESULTS In the final model, young person ACE scores were associated with older child age (β = 0.082, p = .016), younger parental age (β = -0.083, p = .022), fewer children in the household (β = -0.120, p < .001), poor child health (β = 0.160, p < .001), low family support (β = 0.118, p = .001) and the household being in receipt of benefits (β = 0.223, p < .001). CONCLUSIONS This study found a small association between parent and young person ACE exposure which was attenuated through other variables.
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Affiliation(s)
- Lisa Bunting
- Queen's University Belfast, Northern Ireland, United Kingdom.
| | - Claire McCartan
- Queen's University Belfast, Northern Ireland, United Kingdom
| | - Gavin Davidson
- Queen's University Belfast, Northern Ireland, United Kingdom
| | - Anne Grant
- Queen's University Belfast, Northern Ireland, United Kingdom
| | | | - Dirk Schubotz
- Queen's University Belfast, Northern Ireland, United Kingdom
| | - Orla McBride
- Ulster University, Northern Ireland, United Kingdom
| | - Jamie Murphy
- Ulster University, Northern Ireland, United Kingdom
| | - Emma Nolan
- Ulster University, Northern Ireland, United Kingdom
| | - Mark Shevlin
- Ulster University, Northern Ireland, United Kingdom
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Folger AT, Nidey N, Ding L, Ji H, Yolton K, Ammerman RT, Bowers KA. Association Between Maternal Adverse Childhood Experiences and Neonatal SCG5 DNA Methylation-Effect Modification by Prenatal Home Visiting. Am J Epidemiol 2022; 191:636-645. [PMID: 34791022 PMCID: PMC9077120 DOI: 10.1093/aje/kwab270] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 09/21/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Maternal childhood adversity and trauma may elicit biological changes that impact the next generation through epigenetic responses measured in DNA methylation (DNAm). These epigenetic associations could be modified by the early postnatal environment through protective factors, such as early childhood home visiting (HV) programs that aim to mitigate deleterious intergenerational effects of adversity. In a cohort of 53 mother-child pairs recruited in 2015-2016 for the Pregnancy and Infant Development Study (Cincinnati, Ohio), we examined the association between maternal adverse childhood experiences (ACEs) and neonatal DNAm in the secretogranin V gene (SCG5), which is important in neuroendocrine function. We examined prenatal HV as an effect modifier. Mothers completed a questionnaire on ACEs during pregnancy, and infant buccal samples were collected 1 month postpartum. Multivariable linear regression was used to examine the association between maternal ACEs and neonatal DNAm expressed as M-values averaged across 4 cytosine-phosphate-guanine dinucleotide sites. A higher number of maternal ACEs (>3) was associated with a 5.79-percentage-point lower offspring DNAm (95% confidence interval: -10.44, -1.14), and the association was modified by the number of home visits received during pregnancy. In a population of at-risk mother-child dyads, preliminary evidence suggests that maternal ACEs have a relationship with offspring SCG5 DNAm that differs by the amount of prenatal HV.
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Affiliation(s)
- Alonzo T Folger
- Correspondence to Dr. Alonzo Folger, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Mail Location 5041, Cincinnati, OH 45229 (e-mail: )
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Ochoa LG, Fernandez A, Lee TK, Estrada Y, Prado G. The Intergenerational Impact of Adverse Childhood Experiences on Hispanic Families: The Mediational Roles of Parental Depression and Parent-Adolescent Communication. FAMILY PROCESS 2022; 61:422-435. [PMID: 33880753 PMCID: PMC9509697 DOI: 10.1111/famp.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parental exposure to adverse childhood experiences (ACEs) has been documented as a strong risk factor for subsequent externalizing behaviors in their youth. Although studies have investigated ACEs and their intergenerational association with youth externalizing behaviors, this association has not been investigated in Hispanic families. Additionally, substantial gaps in the literature exist explaining the mechanisms by which this association occurs. The purpose of this study was to examine whether parent-adolescent communication and parental depressive symptomatology explain the relationship between parent's ACE score and adolescent externalizing behaviors. This secondary data analysis utilized baseline data from an ongoing randomized controlled trial evaluating the relative effectiveness of an online parenting intervention for Hispanic adolescents. The sample consisted of 456 parents and their adolescents between the ages of 12-16. Using path modeling, parental depressive symptomatology and parent-adolescent communication were simultaneously examined as mechanisms that may explain the intergenerational relationship between parental exposure to ACEs and externalizing behaviors in Hispanic youth. Parental depressive symptomatology and parent-adolescent communication both significantly mediated the association between parental exposure to ACEs and adolescent externalizing behaviors. Understanding the mechanisms explaining the intergenerational association between parental exposure to ACEs and adolescent externalizing behaviors may aid future research examining problematic behaviors in Hispanic youth.
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Affiliation(s)
- Lucas G Ochoa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alejandra Fernandez
- Schwartz Center for Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yannine Estrada
- Schwartz Center for Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Guillermo Prado
- Schwartz Center for Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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