Evidence for Revising the Adverse Childhood Experiences Screening Tool: a Scoping Review

Research Review: Assessment of early-life adversity and trauma - cumulative risk and dimensional approaches

In this research review, we present approaches and recommendations for assessing early-life adversity and childhood trauma aligned with two leading conceptual models of adversity: cumulative risk and dimensional models. We summarize the measurement implications of each conceptual model and common approaches for assessing early-life adversity in studies utilizing each of these models. We consider other critical components in the assessment of early-life adversity and trauma, including retrospective and prospective reporting, objective and subjective measurement, and caregiver and child reporting. Finally, we briefly summarize the existing interview and questionnaire measures that are widely used to assess early-life adversity and trauma using both cumulative risk and dimensional approaches. This work suggests that there is greater heterogeneity in measures used to assess the dimensional model relative to those used to assess the cumulative risk model, which allows for more flexibility in the assessment of early-life adversity. In addition, we observed that more detailed measures were available to assess experiences of threat compared to experiences of deprivation. Measures that assess adversity experiences in terms of frequency and severity across multiple dimensions of experience within a single measure are needed to facilitate consistent and reliable assessment of early-life adversity and trauma, particularly when applying dimensional models.

Association of adverse childhood experiences with physical illness and self-rated health in the population-based Tromsø Study

Adverse childhood experiences (ACEs) are highly prevalent and associated with life-long health consequences. Here, we investigated the relationship of ACEs to adult-onset health outcomes in general population. We conducted a cross-sectional analysis using the seventh survey of the Tromsø Study, including 20 843 participants. Main exposure variables were exposure to at least one ACE, rumination related to adverse experiences, cumulative ACEs, and two clusters of ACEs, i.e. interpersonal and impersonal ACEs. Logistic and ordinal regression models were fitted to estimate the risk of adult-onset physical illness and poor self-rated health adjusted for birth year, sex, smoking, education, and income. We found that exposure to at least one ACE together with rumination was associated with increased risk of hypertension, heart failure, atrial fibrillation, diabetes, obesity, kidney disease, chronic obstructive pulmonary disease, asthma, rheumatoid arthritis, arthrosis, migraine, chronic pain, and poor self-rated health. We observed dose-effect relationships of cumulative ACEs to the aggregated risk of 14 among 16 health outcomes. While increased risk of heart failure, kidney disease, and rheumatoid arthritis was only linked to the interpersonal ACEs, increased risk of coronary artery disease was associated only with the impersonal ACEs. Our findings demonstrate that exposure to ACEs increases the risk of adult-onset physical illness and poor self-rated health in a dose-effect relationship, and rumination related to adverse experiences is associated with an aggravated risk. Inquiry into exposure to ACEs might inform about health risks. Early intervention approaches to promote positive experiences and increase resilience might alleviate life-long health burden.

Integrative Treatment Strategies for Chronic Back Pain: A Literature Review with Clinical Recommendations

PROBLEM

Chronic back pain (CBP) is a major cause of disability, contributing significantly to healthcare costs and primary care visits. Pharmacotherapy alone is insufficient in managing CBP. Integrated behavioral health interventions that include psychoeducation are critical for a more holistic, sustainable treatment of CBP.

OBJECTIVES

This review explores CBP treatments that includes psychoeducation as part of patient care.

METHODS

In the Fall of 2024, the first author searched Google Scholar, PubMed, and Scopus using search terms related to chronic back pain and integrated behavioral interventions to increase patients' self-efficacy to manage CBP. The team included articles in the review that were published more recently and seminal articles in the field of managing CBP.

RESULTS

Given the complex biopsychosocial factors influencing CBP, and the individualized nature of each patient's pain experience, patient psychoeducation should include a multimodal approach, which may include cognitive behavioral strategies to address pain, pain neuroscience education, and education related to lifestyle behaviors such as physical activity, sleep, nutrition, and stress management. Patient education and behavioral interventions integrated within primary care can significantly improve patient engagement and self-reported improvements in pain intensity, functionality, and quality of life.

CONCLUSION

Psychoeducation is foundational for integrative programs aimed at managing CBP.

Maternal adverse childhood experiences and lifetime experiences of racial discrimination: Associations with current household hardships and intergenerational health

Growing evidence shows parents' exposure to adverse childhood experiences (ACEs) and lifetime experiences of racial discrimination (EOD) negatively impacts not only their own health, but also their children's health. ACEs and EOD can be conceptualized as a reflection of shared underlying adversities and structural injustices that manifest in inequitable educational and employment opportunities and differential treatment by public policies and programs that impede parents' capacity to support their families. Therefore, a potentially important, but underexplored, mechanism of effects of parent ACEs and EOD on the next generation is through effects on household material hardships. Using cross-sectional survey data collected from 1629 mothers of young children aged <4 years during pediatric healthcare visits in four US cities (Baltimore, MD; Boston, MA; Little Rock, AR; Philadelphia, PA), we examined individual and joint associations of mothers' ACEs and EOD with their health and their children's health, as well as household-level material hardships. In demographics-adjusted Poisson and multinomial logistic regression models, mothers who had experienced high ACEs, high EOD, or high combined ACE-EOD reported more household hardships and were less likely to report that they and their young children were in good health. Mediation analyses showed evidence that associations with maternal health were partially mediated by household hardships. Our results suggest that maternal ACEs and EOD may undermine maternal and child health via household hardships, along with other potential mechanisms. Counteracting downstream effects of these adversities requires timely intervention on multiple levels, including addressing remediable household hardships. Ultimately, a focus on achieving equity comprehensively through policy design and implementation is needed to realize the full potential of public policies for supporting family and child health.

Screening for Adverse Childhood Experiences: A Critical Appraisal

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.

Micro-level Factors Associated with Youth Drug Use Among an Urban at-Risk Youth Sample

BACKGROUND

Youth drug use has reached global epidemic proportions with unequal distribution among communities with low income, immigrants, or ethnic status.

PURPOSE

This study seeks to understand the association between micro-level factors and youth drug use behavior among 2693 low-income, ethnic, and immigrant youths in Pomona, CA, USA. The study uneath's unique evidence and intervention elements necessary to resolve youth drug use in Pomona.

METHODS

We used social cognitive theory as a conceptual framework, and performed correlation and multiple linear regression analysis in a cross-sectional design.

RESULTS AND DISCUSSION

The results reveal that attitudes, perceptions, and behavior related to friends, participants, family, and adults in the participant's life and ease of access to drugs are associated with youth drug use. Variables related to friends and participants show a relatively stronger association with youth drug use in comparison to variables related to parents and adults in participants' lives. Equally, drug and non-drug antisocial behavior of friends and participants show a stronger association with youth drug use relative to prosocial behavior. Also, when a diverse set of predictor variables are combined together, their association to the outcome variable is stronger than that of a single variable.

RECOMMENDATIONS

Future interventions in Pomona should prioritize strategies which target participants and friends over activities targeting parents and adults. Interventions targeting antisocial behavior should be prioritized over prosocial behavior. Program implementers should also develop unique evidence and tools which will help parents influence the drug use behavior of youths in Pomona and similar communities.

Sex Differences in Stress-Induced Cortisol Response Among Infants of Mothers Exposed to Childhood Adversity

BACKGROUND

Adverse childhood experiences (ACEs) increase risk for mental illness in women and their children, and dysregulation of the hypothalamic-pituitary-adrenal axis may play a role. The impact of ACEs on the hypothalamic-pituitary-adrenal axis may be strongest when ACEs occur prepubertally and in people who are exposed to abuse ACEs.

METHODS

To test this, we measured salivary cortisol in 96 mother-infant dyads while mothers were separated from their infants, who were experiencing a laboratory stressor. Mothers completed the Adverse Childhood Experiences Questionnaire; ACEs that occurred prepubertally (pACEs) were measured, and mother-infant dyads were grouped based on maternal pACE history as follows: no pACEs, ≥1 pACEs with abuse, or ≥1 pACEs but no abuse.

RESULTS

Mothers with ≥1 pACEs exhibited decreases in cortisol (relative to preinfant stressor), which differed significantly from the cortisol increase experienced by mothers with no pACEs, regardless of abuse presence (p = .001) or absence (p = .002). These pACE groups did not differ from one another (p = .929). Significant sex differences in infant cortisol were observed in infants of mothers with ≥1 pACEs (regardless of abuse) but not in infants of mothers with no pACEs. When mothers had experienced ≥1 pACEs, males showed decreases in cortisol in response to a stressor whereas females demonstrated increases, and males and females differed significantly when their mothers had ≥1 pACEs with (p = .025) and without (p = .032) abuse.

CONCLUSIONS

Regardless of maternal exposure to childhood abuse, in response to a stressor, pACEs were associated with lower cortisol response in mothers and sex differences in 6-month-old infants, with males showing a lower cortisol response than females.

Adverse Childhood Experiences, maladaptive coping behaviours and protective factors in undergraduate students: A cross-sectional study

Objectives: The purpose is to examine the relationship between Adverse Childhood Experiences (ACEs), protective factors, and select maladaptive coping behaviors in postsecondary students. Participants: Undergraduate students attending Dalhousie University. Methods: An online anonymous survey was conducted. Zero order one-tailed correlations were computed to measure relationships between ACEs, levels of maladaptive coping behaviors and protective factors. A structural equation mediation model examined direct and indirect pathways between measures. Results: 42.5% of respondents (n = 327) reported ≥3ACEs. Higher ACEs were associated with higher expression of maladaptive coping behaviors. Respondents with high ACEs and low levels of protective factors reported lower levels of hope and forgiveness and higher levels of stress and rumination. Conclusion: Higher levels of protective factors were associated with lower levels of maladaptive coping behaviors in students with high ACEs.

Prevalence and Risk Factors of Gang Membership in a Brazilian Birth Cohort

Importance

There is no longitudinal evidence on risk factors for gang membership in low- and middle-income countries, despite organized crime groups posing major challenges, including high homicide rates in Latin America. Furthermore, adverse childhood experiences (ACEs) have been largely overlooked in gang-related research worldwide.

Objectives

To examine the associations of ACEs up to 15 years of age with past-year gang membership at 18 years of age and to compare crime and criminal justice involvement between gang members and non-gang members.

Design, Setting, and Participants

This cohort study assessed children from the 1993 Pelotas (Brazil) Birth Cohort-an ongoing population-based, prospective study. Assessments were undertaken perinatally (1993) and when the children were ages 11 (2004), 15 (2008), 18 (2011), and 22 (2015) years. All children born in 1993 were eligible (N = 5265), and 5249 (99.7%) were enrolled at birth. The study sample (N = 3794 [72.1%]) included those with complete data on ACEs. Data analyses were conducted from February to August 2024.

Exposures

Twelve ACEs were assessed up to 15 years of age via child self-report and/or maternal report, including physical neglect, physical abuse, emotional abuse, sexual abuse, domestic violence, maternal mental illness, parental divorce, ever being separated from parents, parental death, poverty, discrimination, and neighborhood fear. These experiences were examined using a single adversity approach, cumulative risk, and latent classes.

Main Outcomes and Measures

The main outcome was past-year gang membership at 18 years of age, assessed via self-report and analyzed using multivariate imputation.

Results

Of 3794 participants, 1964 (51.8%) were female and 1830 (48.2%) were male, and 703 (18.5%) were Black, 2922 (77.0%) were White, and 169 (4.5%) were coded as "other" race or ethnicity (no additional details are available to further disaggregate the other category). On the basis of the imputed data, 1.6% (SE, 0.2 percentage points) of participants reported gang membership at 18 years of age. Physical abuse (odds ratio [OR], 2.76; 95% CI, 1.27-5.98), emotional abuse (OR, 2.76; 95% CI, 1.51-5.02), domestic violence (OR, 3.39; 95% CI, 1.77-6.48), parental divorce (OR, 2.04; 95% CI, 1.17-3.54), and separation from parents (OR, 3.13; 95% CI, 1.54-6.37) were associated with an increased risk of gang membership. A dose-response association was observed, with 4 or more ACEs increasing the risk (OR, 8.86; 95% CI, 2.24-35.08). In latent class analysis, the class with child maltreatment and household challenges was associated with a higher risk of gang membership than the low-adversities class (OR, 7.10; 95% CI, 2.37-21.28). There was no robust evidence that children exposed to household challenges and social risks were at increased risk of gang membership (OR, 2.28; 95% CI, 0.46-11.25).

Conclusions and Relevance

In this prospective cohort study, ACEs, particularly child maltreatment and family conflict, were associated with gang involvement when examined individually, cumulatively, and as clusters in a high-crime environment in Brazil. These findings underscore the value of integrating the ACE framework into gang-related research and the potential to reduce gang-related crime by reducing ACEs.

Caregiver Report of Adverse Childhood Events: Comparison of Self-Administered and Telephone Questionnaires

Adverse childhood experiences (ACEs) are traumatic experiences that increase people's susceptibility to adverse physical health, mental health, and social consequences in adulthood. Screening for ACEs in primary care settings is complicated by a lack of consensus on appropriate methods for identifying exposure to ACEs. It is unclear whether self-report methods could increase disclosure of ACEs as compared to interview-based methods. This study compares data on the prevalence of ACEs from two publicly available surveys conducted on the same population of children's caregivers: the 2019 Ohio subsample of the web/mail-based National Survey of Children's Health and the telephone-based 2019 Ohio Medicaid Assessment Survey. We find higher disclosure of caregiver-reported child exposure to ACEs in the telephone interview survey, highlighting the importance of the role of verbal communication in developing a safe and trusting relationship in the disclosure of trauma.

The Influences of Adverse Childhood Experiences and Social Support on Male Teenagers' Gaming Motivation: A Moderated Network Analysis

INTRODUCTION

Strong gaming motivations can lead to gaming-related health problems, but how gaming motivations are formed is unclear. Therefore, we examined the impact of early life experiences on gaming motivations.

METHODS

Questionnaire data on the gaming motivations, adverse childhood experiences, and social support of 2,171 teenaged online game players were modeled using moderated network analysis.

RESULTS

All adverse childhood experience components positively correlated with achievement and escapism motivations (weight range: 0.08-0.40). Social support from friends (weight = -0.04) negatively moderated the relationship between achievement motivation and other adverse childhood experiences and positively moderated (weight = 0.01) the relationship between escapism motivation and familial dysfunction.

DISCUSSION

The findings indicate that adverse childhood experiences foster negative gaming motivations. Additionally, social support moderates the relationship between adverse childhood experiences and gaming motivations. These findings offer valuable insights that nursing practitioners can apply to gaming-related health problem interventions and prevention in teenagers.

Adverse childhood experiences and crime outcomes in early adulthood: A multi-method approach in a Brazilian birth cohort

This study aimed to investigate alternative approaches to a cumulative risk score in the relationship between adverse childhood experiences (ACEs) and crime. Using data from the 1993 Pelotas (Brazil) Birth Cohort (n = 3236), we measured 12 ACEs up to 15 years, and past-year violent and non-violent crime at 22 years. We used four analytical approaches: single adversities, cumulative risk, latent class analysis, and network analysis. When examined individually, physical abuse, emotional abuse, and domestic violence were associated with both crime outcomes, whereas maternal mental illness and discrimination were associated with violent crime only, and parental divorce and poverty with non-violent crime only. There was a cumulative effect of ACEs on crime. The class with child maltreatment and household challenges was associated with both crime outcomes; exposure to household challenges and social risks was associated with violent crime only. In network models, crime showed conditional associations with physical abuse, maternal mental illness, and parental divorce. Although cumulative ACEs did associate with crime, some individual and combinations of ACEs showed particularly strong and robust effects, which were not captured by the cumulative score. Many ACEs are closely connected and/or cluster together, and the usefulness of the ACE score needs to be further evaluated.

A Short Adverse Experiences Measure Among Mothers of Young Children

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Self-Reported Adverse Childhood Experiences and Risk for Internalizing and Externalizing Difficulties among Adolescent Custodial Grandchildren

Despite custodial grandchildren's (CG) traumatic histories and risk for psychological difficulties, knowledge is scant regarding the frequencies, types, and consequences es of adverse childhood experiences (ACEs) they have encountered. We examined self-reported ACEs via online surveys with 342 CG (ages 12 to 18) who were recruited to participate in an RCT of a social intelligence training program. ACEs were assessed by 14 widely used items, and risk for internalizing (ID) and externalizing (ED) difficulties were measured using 80th percentile cut-offs on the Strengths and Difficulties Questionnaire. Classification and regression tree analyses included all 14 ACEs (along with CG gender and age) as predictors of ID and ED risk separately. Given possible comorbidity, analyses were run with and without the other risk type as a predictor. Less than 9% of CG self-reported no ACEs, 48.6% reported two to five ACEs, and 30.5 % reported ≥ 6. Irrespective of ED risk, bullying from peers strongly predicted ID risk. ED risk was peak among CG who also had risk for ID. Without ID risk as a predictor, ED risk was highest among CG who were emotionally abused, not lived with a substance abuser, and encountered neighborhood violence. The frequency and types of ACEs observed were alarmingly higher than those among the general population, suggesting that many CG have histories of trauma and household dysfunction. That a small number of ACEs among the 14 studied here were significant predictors of ID and ED risk challenges the widespread belief of a cumulative dose ACE effect.

Exploratory study evaluating the relationships between perinatal adversity, oxidative stress, and infant neurodevelopment across the first year of life

Early childhood adversity increases risk for negative lifelong impacts on health and wellbeing. Identifying the risk factors and the associated biological adaptations early in life is critical to develop scalable early screening tools and interventions. Currently, there are limited, reliable early childhood adversity measures that can be deployed prospectively, at scale, to assess risk in pediatric settings. The goal of this two-site longitudinal study was to determine if the gold standard measure of oxidative stress, F2-Isoprostanes, is potentially a reliable measure of a physiological response to adversity of the infant and mother. The study evaluated the independent relationships between F2-Isoprostanes, perinatal adversity and infant neurocognitive development. The study included mother-infant dyads born >36 weeks' gestation. Maternal demographic information and mental health assessments were utilized to generate a perinatal cumulative risk score. Infants' development was assessed at 6 and 12 months and both mothers and infants were assayed for F2-isoprostane levels in blood and urine, respectively. Statistical analysis revealed that cumulative risk scores correlated with higher maternal (p = 0.01) and infant (p = 0.05) F2-isoprostane levels at 6 months. Infant F2-isoprostane measures at 2 months were negatively associated with Mullen Scales of Early Learning Composite scores at 12 months (p = 0.04). Lastly, higher cumulative risk scores predicted higher average maternal F2-isoprostane levels across the 1-year study time period (p = 0.04). The relationship between perinatal cumulative risk scores and higher maternal and infant F2-isoprostanes at 6 months may reflect an oxidative stress status that informs a sensitive period in which a biomarker can be utilized prospectively to reveal the physiological impact of early adversity.

Adverse childhood experiences: impacts on adult mental health and social withdrawal

Background

Adverse childhood experiences (ACEs) have been found to negatively impact adult mental health outcomes. Numerous studies have highlighted on ACEs in family and community settings. However, few have examined the impact of ACEs in school settings, despite the potential influence on social participation. Hikikomori, characterized by severe social withdrawal, was first studied in Japan and has gained recognition in recent years. The present study aims to present the concept of ACEs specific to schools and investigate the impact of both school ACEs and traditional ACEs on adult mental health and Hikikomori.

Methods

A total of 4,000 Japanese adults, aged 20-34, were recruited through an Internet survey form. All data were obtained in October 2021. Participants answered questions regarding their ACEs in the family (10 items), school ACEs (five teacher-related items and two bullying-related items), depressive/anxiety symptoms, and Hikikomori (remaining at home for more than 6 months).

Results

A significant association with depressive/anxiety symptoms was shown in both ACEs and school ACEs. An increase of one point in the ACE scores was associated with a 24% increase in the risk of depressive/anxiety symptoms. School ACE scores also demonstrated a significant association with depressive/anxiety symptoms, with an increase of one point associated with a 44% increase in the risk of these symptoms. As for Hikikomori, a significant association was shown in the school ACEs only: a 29% increased risk of Hikikomori for every one-point increase in school ACE scores. Both school ACE scores for teacher-related and bullying-related factors revealed a significant association with Hikikomori; the rates of increased risk were 23 and 37%, respectively.

Conclusion

These results suggest that school ACEs, rather than ACEs in the family, are associated with the risk of Hikikomori. School ACEs are important for social adaptation, and reducing traumatic experiences in school settings may have the potential to prevent problems in later life, specifically in terms of social participation.

Adverse childhood experiences and stress among oral health students: a descriptive correlational study

Background

Stress is a challenge to many post-secondary students and, if prolonged and unmanaged, can affect academic success. Understanding factors that contribute to students' stress is important. One possible contributor may be adverse childhood experiences (ACEs); that is, traumatic events that occur during the first 18 years of life. Inverse relationships between the number of ACEs and indicators of poor mental well-being have been proposed.

Objective

To describe ACEs in oral health students (OHS) and the associations between the number and types of ACEs and levels of perceived stress, an indicator of mental well-being.

Methods

Invitations to participate in an anonymous online cross-sectional survey were sent to all OHS, 19 years and older, attending Dalhousie University in Halifax, Nova Scotia, Canada. Self-reports of ACEs and perceived stress were collected. Zero-order correlations and regression modelling were used to examine associations.

Results

Twenty-six percent (26%, n = 66) of OHS completed the survey. Respondents reported an average of 2.20 ACEs; 34.9% reported ≥ 3 ACEs. Emotional abuse (41%) was the most reported ACE. Associations were observed between numbers of ACEs and stress. Levels of stress increased with the number of ACEs (r = 0.23, p < 0.05). Regression modelling determined levels of stress were not affected by ACE type (F (3,62) = 2.24, p = 0.092).

Discussion

This was the first study to examine associations between ACEs and perceived stress in OHS. These students reported greater numbers of ACEs than age-matched general populations. Levels of stress were associated with numbers of ACEs.

Conclusion

Faculty in dental and dental hygiene programs should recognize the prevalence of ACEs among OHS and the potential impact on their mental well-being.

Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics

PURPOSE

To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care.

METHODS

We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals.

RESULTS

Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening.

CONCLUSIONS

Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.

Addressing Adverse Childhood Experiences and Psychological Symptoms Among Bariatric Patients

Adverse Childhood Experiences (ACEs) have been shown to be prevalent in bariatric surgery candidates with comorbid psychological symptoms. While bariatric patients who have mental illness or a history of ACEs are less likely to lose weight, presence of a support system has been reported to mitigate ACEs' effects and to maintain long-term weight loss. The current study aims to examine the association between ACEs and psychological symptoms and the effect of potential protective factors on the association among bariatric patients. The study included a total of 199 subjects seeking bariatric surgery who completed a psychological evaluation including ACEs, psychological symptoms, and presence of support system as part of the presurgical multidisciplinary weight management consultations at a large university hospital. Multivariate regression models were used to examine the association between ACEs and psychological symptoms and potential effect of support system on the association. The study found that there is a significant association between ACEs and psychological symptoms. The study also revealed that patients who reported having a childhood supportive person were significantly associated with a lower BMI, while those who reported having adulthood supportive person showed significantly less symptoms of depression, anxiety, and binge eating. The findings have significant implications that addressing ACEs in preoperative surgical process in relation to psychological conditions and therapeutic interventions within their close environmental system will be beneficial for patients to achieve optimal surgical outcomes.

Adverse childhood experiences and alcohol use and misuse: Testing the impact of traditional and expanded adverse childhood experiences among racially/ethnically diverse youth transitioning into adulthood

Objective

Traditional Adverse Childhood Experiences (T-ACEs), such as abuse and neglect, have been associated with an increased risk of youth alcohol use and misuse. This study aims to compare associations of T-ACEs and Expanded ACEs (E-ACEs), an expanded set of ACEs that encompass community-level adversities, with alcohol use and misuse by race/ethnicity.

Method

Data came from a three-wave (1998-1999; 1999-2000; 2004-2005) community-based study in Houston, including youth transitioning into adulthood. We compared associations between ACEs at Wave 1 and past-year alcohol use, abuse, and dependence at Wave 3.

Results

Participants (n = 2,391) included White (n =908), Black (n = 898) and Latinx (n = 585) youth (M (SD) = 14.00 (2.04)) transitioning into young adulthood (M (SD) = 19.77 (2.34)). T-ACEs were associated with higher odds of alcohol use, abuse, and dependence (OR = 1.15, OR = 1.18, OR = 1.24, respectively) while E-ACEs increased the odds of alcohol dependence (OR = 1.23) in the total sample. No significant differences by race/ethnicity were found. Racial/ethnic differences in increased alcohol risk were observed for some ACE items, such as bullying and use for Latinx youth (OR = 2.13) and poverty and dependence for White youth (OR = 2.01).

Conclusions

T-ACES and E-ACEs increase the risk of alcohol use and misuse. Results highlight the importance of preventing ACEs exposure as a risk factor for youth alcohol use and misuse. Public policies must also focus on preventing ACEs through multi-level interventions aimed at reducing violence, bullying, and financial instability.

Youth Suicide and Self-Harm: Latent Class Profiles of Adversity and the Moderating Roles of Perceived Support and Sense of Safety

Research suggests that exposure to adversity can lead to an increased risk of experiencing suicidal and self-injurious thoughts or behaviours, but few studies have examined whether different patterns of adversity are differentially associated with youth suicide/self-harm. The current study aims to explore the relationship between exposure to adversity across various social domains and youth self-harm and suicidality, using a person centred approach, and examines whether access to social support and a sense of safety across home, peer or school settings buffer the relationship between adversity and self-harm/suicidality. Secondary data analyses were carried out on cross-sectional self-report data collected from 4848 (M_age=15.78, SD = 0.59; 50% female) adolescents who participated in the Irish Planet Youth survey. Latent Class Analyses identified four distinct profiles of adversity; low-adversity (n = 2043, 42%); peer-adversity (n = 972, 20%); parental-adversity (n = 1189, 25%); and multiple-adversity (n = 644, 13%). Findings from logistic moderated regressions indicated that there were significant differences in self-harm and suicidality across the adversity classes. Although parental support and perceived safety at school were negatively associated with suicidality and self-harm outcomes, no significant moderation effects were observed. These findings suggest that youth who experience adversity across multiple social domains are more likely to report suicidal and self-harm thoughts and behaviours, and should be key targets for intervention/prevention efforts. While parental support and school safety may act as significant compensatory factors, further work is needed to identify the social resources that can offset the risk imposed by youth's adverse experiences.

The Subjective Impact and Timing of Adversity Scale: A Feasibility Study Using Cross-Sectional and Longitudinal Data

This study assessed the feasibility of a multi-domain measure of the occurrence, impact, and timing of childhood/adolescent psychological adversity exposure, the Subjective Impact and Timing of Adversity Scale (SITA). Participants were from among those who had previously participated in two waves of data collection when aged approximately 14 and 21 years. Internal consistency estimates at both online and interview stages were acceptable for all SITA domains (with the exception of parental loss). SITA domain scores correlated meaningfully with scores on other scales and psychological measures, supporting convergent validity. Those with lifetime psychiatric diagnoses scored significantly higher on SITA domains than those not meeting diagnostic threshold. There was evidence of the importance of both the subjective impact and timing of adversity with regard to psychiatric diagnoses. The study demonstrates the viability of the SITA; however, further studies are required to substantiate these findings in larger samples.