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Lewis KN, McKelvey LM. Positive childhood experiences support emotional and behavioral health in middle childhood: Longitudinal mediation of adverse childhood experiences. CHILD ABUSE & NEGLECT 2025; 163:107320. [PMID: 39985881 DOI: 10.1016/j.chiabu.2025.107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 02/24/2025]
Abstract
BACKGROUND Fostering positive childhood experiences (PCEs) is a key prevention strategy, however there is a scarcity of longitudinal studies that explore the role of PCEs with childhood outcomes. OBJECTIVE This study examined the impact of middle childhood PCEs in the presence of earlier adverse childhood experiences (ACEs) on indices of behavioral and emotional development. PARTICIPANTS AND SETTING 1163 participants from the U.S. Early Head Start Research and Evaluation Project (EHSRE). METHODS Ten PCEs indicators (PCE-G5) that align with the Health Outcomes from Positive Experiences (HOPE) framework were identified in the Grade 5 EHSRE data. The convergent validity of the PCE-G5 for internalizing, externalizing, and social problems was tested with hierarchical linear regressions, controlling for infant/toddler ACEs (ACE-IT). We also examined whether PCE-G5 mediated the association between ACE-IT and internalizing, externalizing, and social problems using path analyses. RESULTS Children had 7.6 PCEs, on average. PCE-G5 scores were associated with fewer internalizing (β = -1.000, p < 0.001), externalizing (β = -1.183, p < 0.001), and social problems (β = -0.420, p < 0.001). PCE-G5 partially mediated the effect of ACE-IT on internalizing, externalizing, and social problems (respective indirect effects β = 0.027; β = 0.028; β = 0.037; all p < 0.001). CONCLUSIONS Our study adds evidence of an inverse association between PCEs and middle childhood behavioral and emotional problems. The mediating impact of PCEs suggests that the exposure to early childhood ACEs may reduce the opportunities for involvement in PCEs, thereby increasing the risks for internalizing behavior, externalizing behavior, and social problems. Findings highlight the benefit of opportunities for PCEs for children who have been exposed to ACEs.
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Affiliation(s)
- Kanna N Lewis
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
| | - Lorraine M McKelvey
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
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Fonseca de Freitas D, Bhui K, Clesse C, Zahid U, Mooney R, Joury E, Hayes RD, Khondoker M. A syndemic approach to the study of Covid-19-related death: a cohort study using UK Biobank data. J Public Health (Oxf) 2025; 47:e77-e85. [PMID: 39676287 PMCID: PMC11879006 DOI: 10.1093/pubmed/fdae310] [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: 03/17/2024] [Revised: 08/11/2024] [Accepted: 11/28/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic showed higher infection, severity and death rates among those living in poorer socioeconomic conditions. We use syndemic theory to guide the analyses to investigate the impact of social adversity and multiple long-term conditions (MLTC) on Covid-19 mortality. METHODS The study sample comprised 154 725 UK Biobank participants. Structural equation modeling was used to investigate pathways between traumatic events, economic deprivation, unhealthy behaviors, MLTC, for Covid-19 mortality. Cox regression analysis was used to investigate MLTC and Covid-19 mortality. We also tested effect modification by traumatic events, economic deprivation and unhealthy behaviors. RESULTS Covid-19 mortality (n = 186) was directly explained by overall level of MLTC. Economic deprivation and unhealthy behaviors contributed to Covid-19 death indirectly via their negative impact on MLTC. The risk for Covid-19 mortality grew exponentially for every quintile of predicted scores of MLTC. The presence of traumatic events, economic deprivation or unhealthy behaviors did not modify the impact of MLTC on Covid-19 mortality. CONCLUSIONS Results suggest a serially causal pathway between economic deprivation and unhealthy behaviors leading to MLTC, which increased the risk of Covid-19 mortality. Policies to tackle the social determinants of health and to mitigate the negative impact of multimorbidity are needed.
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Affiliation(s)
- Daniela Fonseca de Freitas
- CHiMES Collaborative, Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Health Service England, London, UK
| | - Kamaldeep Bhui
- CHiMES Collaborative, Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford. WPA Collaborating Centre, Oxford, UK
- East London and Oxford Health National Health Service Foundation Trusts, Oxford Health Biomedical Research Centre, Global Policy Institute, Queen Mary University of London, London, UK
| | - Christophe Clesse
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- School of Psychology, Whitelands College, University of Roehampton, London, UK
| | - Uzma Zahid
- CHiMES Collaborative, Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Roisin Mooney
- CHiMES Collaborative, Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Easter Joury
- Dental Public Health, Faculty of Medicine and Dentistry, Queen Mary University of London and Barts Health National Health Service Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Delaney KR, Gomes M, Browne NT, Jordan D, Snethen J, Lewis-O'Connor A, Horowitz JA, Cogan R, Duderstadt KG. The mental and behavioral health crisis in youth: Strategic solutions post COVID-19 pandemic: An American Academy of Nursing consensus paper. Nurs Outlook 2024; 72:102177. [PMID: 38901064 DOI: 10.1016/j.outlook.2024.102177] [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: 12/29/2023] [Revised: 03/15/2024] [Accepted: 04/20/2024] [Indexed: 06/22/2024]
Abstract
The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness.
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Affiliation(s)
| | - Melissa Gomes
- Psychiatric, Mental Health, and Substance Use Expert Panel; Health Equity Expert Panel
| | | | - Dorothy Jordan
- Psychiatric, Mental Health, and Substance Use Expert Panel
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McLeay SG, Mathews T, Leeza Struwe. Psychoeducation group facilitation training for nurses: A quality improvement project. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12476. [PMID: 39039576 DOI: 10.1111/jcap.12476] [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: 05/23/2023] [Revised: 07/03/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND According to the 2020-2021 National Survey of Children's Health, 23.3% of children and adolescents met criteria for one or more mental, emotional, developmental, or behavioral problems. However, the prevalence of depression, anxiety, and post traumatic stress disorder have risen dramatically since the COVID-19 pandemic, leading to an increase in suicidal ideations, completed suicides, and pediatric psychiatric hospitalizations. There is a critical need for high quality mental healthcare treatments, including psychoeducation. Inpatient psychiatric nurses are well positioned to lead psychoeducation groups, but few receive training. LOCAL PROBLEM Nurses at a designated inpatient pediatric psychiatric unit expressed discomfort in facilitating psychoeducation groups. METHODS This is a one-group prepost and follow-up quality improvement study designed to improve the quality of psychoeducation group facilitation skills provided by nurses at a child and adolescent inpatient psychiatric unit. A convenience sample of nurses (N = 16) participated. Baseline (T1), post-test (T2), and follow-up (T3) data were collected regarding nurses' self-efficacy, evidence based-practice attitudes, and knowledge of psychoeducation group facilitation. INTERVENTIONS Nurses received 45 min of psychoeducation group facilitation education and 15 min of skills simulation. RESULTS The nurses' knowledge, self-efficacy, and attitudes toward evidence-based practice when facilitating psychoeducation groups increased significantly from the baseline to the post-test, which was sustained from the post-test to the follow-up period. CONCLUSION Study findings indicate the importance of supporting nurses in their role of psychoeducation group facilitation through education and program structure. Further research is needed to assess longer term sustainability and efficacy in leading psychoeducation groups.
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Affiliation(s)
- Shanon G McLeay
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Therese Mathews
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Harding KB, Di Ruggiero E, Gonzalez E, Hicks A, Harrington DW, Carsley S. Supporting Ontario public health units to address adverse childhood experiences in pandemic recovery planning: A priority-setting exercise. Health Res Policy Syst 2024; 22:68. [PMID: 38872217 PMCID: PMC11170865 DOI: 10.1186/s12961-024-01156-0] [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: 10/19/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans. METHODS The Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May-October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario's 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units' work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options. RESULTS In all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO's scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice. CONCLUSIONS Over three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.
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Affiliation(s)
- Kimberly B Harding
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erick Gonzalez
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
| | - Amanda Hicks
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Daniel W Harrington
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada
| | - Sarah Carsley
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.
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Tan Y, Pinder D, Bayoumi I, Carter R, Cole M, Jackson L, Watson A, Knox B, Chan-Nguyen S, Ford M, Davison CM, Bartels SA, Purkey E. Family and community resilience: a Photovoice study. Int J Equity Health 2024; 23:62. [PMID: 38504281 PMCID: PMC10949719 DOI: 10.1186/s12939-024-02142-2] [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: 12/05/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person's risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions as well as positive growth in the face of sudden or challenging life events, trauma, or adversities. This study aimed to identify factors contributing to family and community resilience from the perspective of families who self-identified as having a history of adversity and being resilient during the COVID-19 pandemic. METHODS This study used Photovoice, a visual participatory research method which asks participants to take photographs to illustrate their responses to a research question. Participants consisted of a maximum variation sample of families who demonstrated family level resilience in the context of the pair of ACEs during the COVID-19 pandemic. Family members were asked to collect approximately five images or videos that illustrated the facilitators and barriers to well-being for their family in their community. Semi-structured in-depth interviews were conducted using the SHOWeD framework to allow participants to share and elucidate the meaning of their photos. Using thematic analysis, two researchers then independently completed line-by-line coding of interview transcripts before collaborating to develop consensus regarding key themes and interpretations. RESULTS Nine families were enrolled in the study. We identified five main themes that enhanced family resilience: (1) social support networks; (2) factors fostering children's development; (3) access and connection to nature; (4) having a space of one's own; and (5) access to social services and community resources. CONCLUSIONS In the context of additional stresses related to the COVID-19 pandemic, resilient behaviours and strategies for families were identified. The creation or development of networks of intra- and inter-community bonds; the promotion of accessible parenting, housing, and other social services; and the conservation and expansion of natural environments may support resilience and health.
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Affiliation(s)
- Yvonne Tan
- School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Danielle Pinder
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada
| | - Imaan Bayoumi
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Rifaa Carter
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Michele Cole
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Logan Jackson
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Autumn Watson
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Bruce Knox
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Sophy Chan-Nguyen
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
| | - Meghan Ford
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada
| | - Susan A Bartels
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada
- Department of Emergency Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L 4V7, Canada
| | - Eva Purkey
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada.
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Day ME, Sucharew H, Burkhardt MC, Reyner A, Giles D, Beck AF, Schlaudecker EP, Klein M. High Caregiver Adverse Childhood Experiences Are Associated With Pediatric Influenza and COVID-19 Vaccination Uptake. J Pediatric Infect Dis Soc 2023; 12:595-601. [PMID: 37846858 PMCID: PMC10725238 DOI: 10.1093/jpids/piad090] [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: 12/07/2022] [Accepted: 10/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Factors surrounding vaccine uptake are complex. Although anxiety, which could influence vaccination decisions, has been associated with adverse childhood experiences (ACEs), little is known about links between caregiver ACEs and pediatric vaccine uptake. We evaluated associations between caregivers' ACEs and decisions to vaccinate their children with influenza and coronavirus disease (COVID-19) vaccines. METHODS A cross-sectional study of caregivers of patients ≥6 months at one pediatric primary care center (PPCC) was performed. Caregivers completed a 19-question survey examining caregiver ACEs, influenza vaccine acceptance and beliefs, and intention to vaccinate their child with the COVID-19 vaccine. Demographic characteristics, social risks (eg, housing and food insecurity), and vaccination data for children present with each caregiver were extracted from the electronic health record (EHR). Statistical analyses included χ2 tests for categorical variables and t-tests for continuous variables. RESULTS A total of 240 caregivers participated, representing 283 children (mean age of 5.9 years, 47% male). Twenty-four percent (n = 58) had high ACEs (≥4). Of those with high ACEs, 55% accepted pediatric influenza vaccination compared with 38% with low ACEs (P = .02). Those with high ACEs had more positive attitudes toward influenza vaccine safety and efficacy (P ≤ .02). Those with high, compared with low, ACEs were also more likely to accept COVID-19 vaccination (38% vs 24%; P = .04). CONCLUSIONS Pediatric influenza vaccination rates and intention to vaccinate children against COVID-19 differed between caregivers with high and low ACEs: those with more ACEs were more likely to vaccinate. Further studies assessing the role of caregiver ACEs on vaccine decision-making are warranted.
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Affiliation(s)
- Melissa E Day
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Carol Burkhardt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Allison Reyner
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Destiney Giles
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Lewis KN, McKelvey LM, Zhang D, Moix E, Whiteside-Mansell L. Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood. CHILD ABUSE & NEGLECT 2023; 145:106396. [PMID: 37573799 DOI: 10.1016/j.chiabu.2023.106396] [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: 04/10/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The American Academy of Pediatrics recommends all pediatricians to be ready to implement trauma-informed care, including the mitigation of impacts of Adverse Childhood Experiences (ACEs) through screening and identification of at-risk population. Reliable survey tools and knowledge of the consequences of ACEs are needed. OBJECTIVE This study examines the healthcare utilization and diagnoses captured in insurance claims in association with the number of ACEs recorded by the Family Map Inventories (FMI). The FMI offers a comprehensive family assessment, which includes child ACEs (FMI-ACEs) using prospective, proxy risk indicators. PARTICIPANTS AND SETTING Low-income families (N = 1647) with children aged three to five years who completed the FMI were linked to their insurance records. METHODS Multivariable logistic and generalized linear regression models were fitted to explore the association between the number of ACEs (FMI-ACEs scores) and healthcare utilization and health outcomes. RESULTS Children were exposed at rates of 32.4 % to zero, 31.7 % to one, 19.7 % to two, and 16.3 % to three or more ACEs. The FMI-ACEs scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACEs scores than those with zero FMI-ACEs. CONCLUSIONS This study marks the first effort to conduct insurance claims data review to ascertain association between a survey measure of ACEs and health utilization and diagnosed conditions. The association of ACEs risk screening and healthcare utilization and diagnoses was observed.
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Affiliation(s)
- Kanna N Lewis
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
| | - Lorraine M McKelvey
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Dong Zhang
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Elise Moix
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Leanne Whiteside-Mansell
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
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Angelino AC, Burns J, Deen JF, Empey A. Late, Again: Moving Beyond ACEs in American Indian Communities. Pediatrics 2023; 152:e2023062207. [PMID: 37855053 DOI: 10.1542/peds.2023-062207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Alessandra C Angelino
- Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Burns
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Jason F Deen
- Department of Pediatrics, University of Washington, Seattle, Washington (Blackfeet)
| | - Allison Empey
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon, (Confederated Tribes of Grand Ronde)
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Contextualizing Adverse Childhood Experiences: The Intersections of Individual and Community Adversity. J Youth Adolesc 2023; 52:570-584. [PMID: 36445650 DOI: 10.1007/s10964-022-01713-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
Adverse Childhood Experiences (ACEs) are traumatic childhood events that can undermine youth development, and are linked to chronic health problems, mental illness, and risk-taking behaviors in adulthood. ACEs are preventable, yet effective response strategies require comprehensive conceptualization and measurement of adversity. Although typically measured as individual experiences in the family and home (e.g., abuse, neglect), adversity also exists outside the home, in the many contexts in which youth development unfolds (e.g., communities, neighborhoods). Yet, such contexts and experiences are often absent in ACEs research. Using data from a nationally representative youth sample, this study addresses that gap, advancing a measure that contextualizes individual-level ACEs within social and structural domains of community-level adversity. Among 13,267 youth (mean age = 15.25 [range 12-18]; 51% female; 71% White; 13% Black; 10% Hispanic; 3% Asian; 2% American Indian/Multiracial), 61% and 73% were exposed to at least one individual and community ACE, respectively, while 15% of youth reported severe individual ACE exposure (≥3 ACEs) and 20% were exposed to severe (≥3) community ACEs. All ACE exposures were associated with problem behaviors later in adolescence, but youth reporting both severe individual and community ACEs were especially at high risk for later violence, delinquency, and other health-risk behaviors. These findings highlight that community adversity exacerbates the damaging effects of individual/family adversity and thus should be addressed in efforts to prevent ACEs and reduce their long-term harm.
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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: 1.0] [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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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Witt WP, Harlaar N, Palmer A. The Impact of COVID-19 on Pregnant Women and Children: Recommendations for Health Promotion. Am J Health Promot 2023; 37:282-288. [PMID: 36646662 DOI: 10.1177/08901171221140641e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
COVID-19 continues to have severe repercussions on children and pregnant women. The repercussions include not only the direct impact of COVID-19 (ie, children getting infected by COVID-19) but also indirect impacts (eg, safeguarding from child maltreatment, obesogenic behaviors, language and socioemotional development, educational consequences [eg, interrupted learning]; social isolation; mental health; behavioral health [eg, increased substance use in adolescence]; health and economic impact of COVID-19 on caregivers and family relationships. It has also shed light on long-standing structural and socioeconomic issues, including equity in nutrition and food security, housing, childcare, and internet access. Using a socioecological, life course, and population health approach, we discuss the implications for pregnant women and children's health and well-being and give recommendations for mitigating the short and long-term deleterious impact COVID- 19 on women, children, and their families.
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Steen JT, Kravitz T. Social Workers and Physical Health: Imperative Medical Issues and COVID-19. HEALTH & SOCIAL WORK 2023; 48:75-78. [PMID: 36453899 DOI: 10.1093/hsw/hlac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Jeffrey T Steen
- is assistant professor, School of Social Work, Barry University, 11300 NE 2nd Avenue, Miami Shores, FL 33161, USA
| | - Taylor Kravitz
- is a postbaccalaureate student, Postbaccalaureate Prehealth Studies Program, New York University, New York, NY, USA
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Webb NJ, Miller TL, Stockbridge EL. Potential effects of adverse childhood experiences on school engagement in youth: a dominance analysis. BMC Public Health 2022; 22:2096. [PMID: 36384490 PMCID: PMC9668388 DOI: 10.1186/s12889-022-14524-8] [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: 06/23/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) can have severe negative impacts on childhood and adult health via worsened school engagement and educational outcomes. This study seeks to identify the relative importance of various ACEs in predicting school engagement. Methods We analyzed data from the National Survey of Children’s Health for school-aged children (ages 6-17) for 2018 and 2019. The primary outcome was school engagement, measured through three variables: repeating a grade, doing required homework, and caring about doing well in school. We conducted three logistic regression models with dominance analyses to identify the relative importance of ACE variables in predicting school engagement outcomes. Results In unadjusted and adjusted dominance analyses, parental incarceration was the most important ACE in predicting repeating a grade. Living in a household in which it was hard to cover basics like food or housing was the most important ACE in predicting doing required homework and caring about doing well in school. Discussion Our study points toward the large influence of out-of-school factors on school engagement. Parental incarceration and economic hardship, the most important predictors of engagement, are issues that can be addressed and mitigated through policy interventions. With limited funds available for education and public health interventions, it is crucial that these two ACEs be priority considerations when developing policy. A multi-faceted approach that reduces the incarcerated population, encourages economic well-being, and emphasizes early-childhood education has the potential to significantly improve school engagement in vulnerable populations and ultimately advance social equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14524-8.
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Choudhury S, Yeh PG, Markham CM. Coping with adverse childhood experiences during the COVID-19 pandemic: Perceptions of mental health service providers. Front Psychol 2022; 13:975300. [PMID: 36160597 PMCID: PMC9493451 DOI: 10.3389/fpsyg.2022.975300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Adverse Childhood Experiences (ACEs) have been associated with long-term physical and mental health conditions, toxic stress levels, developing unstable interpersonal relationships, and substance use disorders due to unresolved childhood adversities. Aims This study assessed the perspectives of mental health providers (MHPs) regarding their adult patients’ coping with ACEs during COVID-19 in Houston, Texas. Specifically, we explored how individuals with ACEs are coping with the increased stresses of the pandemic, how MHPs may provide therapeutic support for individuals with ACEs during this pandemic, pandemic-related challenges of accessing and utilizing mental health services for individuals with ACEs, and the awareness and treatment of ACEs among MHPs. Methods Ten in-depth semi-structured virtual interviews were conducted with licensed MHPs from November 2021 to April 2022 in Houston, Texas. Interviews were coded and analyzed for emerging themes through an inductive open coding approach to discover insights regarding coping with ACEs during COVID-19. Results Four key themes experienced by individuals with ACEs emerged from the MHP interviews: (1) Maladaptive emotional dissonance and coping outlets during the pandemic, (2) Difficulties with social connectedness and significance of social support, (3) Heightened daily life stressors and coping with the ongoing disruption of the pandemic, and (4) Changing interactions with the mental health system. Themes from this study highlighted that resilience, seeking treatment, and strong social support can help develop healthy coping strategies among individuals with ACEs. Conclusion This study may help inform best clinical practices to develop interventions and policies regarding ACEs such as a resilience-promotion approach that targets all the socio-ecological levels. In addition, findings highlight the synergy of psychotherapeutic and pharmacological management via tele-health modalities, in helping individuals with ACEs continue receiving the care they deserve and need during a persistent pandemic and an uncertain future.
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Affiliation(s)
- Sumaita Choudhury
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- *Correspondence: Sumaita Choudhury,
| | - Paul G. Yeh
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, The University of Texas Health Science Center at Houston School of Public Health, Brownsville, TX, United States
| | - Christine M. Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
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O'Donnell M, McKinnon S. Advocating for Change to Meet the Developmental Needs of Young Children Experiencing Homelessness. Am J Occup Ther 2022; 76:23885. [PMID: 35984484 DOI: 10.5014/ajot.2022.050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young children experiencing homelessness are at considerable risk for developing physical and cognitive impairments, yet federal and state programs often overlook their needs. Although early intervention programs should serve as family-centered, health-promoting resources for families experiencing homelessness, many do not locate and comprehensively screen eligible children ages ≤3 yr in their communities. Occupational therapy practitioners have a role in advocating for improved access to high-quality, federally mandated programming for this population. They should be aware of the barriers faced by homeless families in accessing equitable early developmental services and of strategies to support individual families and communities experiencing homelessness.
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Affiliation(s)
- Mary O'Donnell
- Mary O'Donnell, OT, OTD, OTR, is Instructor, Entry-Level OTD Program, MGH Institute of Health Professions, Boston, MA;
| | - Sarah McKinnon
- Sarah McKinnon, OT, OTD, OTR, BCPR, MPA, is Program Director, Post-Professional OTD Program, MGH Institute of Health Professions, Boston, MA
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Browne A, Stafford O, Berry A, Murphy E, Taylor LK, Shevlin M, McHugh L, Carr A, Burke T. Psychological Flexibility Mediates Wellbeing for People with Adverse Childhood Experiences during COVID-19. J Clin Med 2022; 11:377. [PMID: 35054070 PMCID: PMC8778161 DOI: 10.3390/jcm11020377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The psychological impact of COVID-19 is multifaceted, both acute and chronic, and has not affected everyone equally. METHOD This longitudinal study compared those with and without Adverse Childhood Experiences (ACEs) on measures of psychological distress and wellbeing over time. RESULTS All groups (No ACE, Low ACE, and High ACE) had similar levels of distress at Time 1, with significant increases in psychological distress for those with ACEs over time, but not for those without. Psychological Flexibility was strongly and significantly associated with decreases in psychological distress and improved wellbeing. It significantly mediated the relationship between ACE and wellbeing. CONCLUSIONS Those with ACEs report significantly increased psychological distress over time, compared to those without ACE during the COVID-19 pandemic. Evidence-based interventions using Psychological Flexibility may improve mental health and wellbeing to help further mediate its effects.
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Affiliation(s)
- Angela Browne
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
| | - Owen Stafford
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
| | - Anna Berry
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
- Health Service Executive, CHO 8 (Laois/Offaly), R32 YFW6 Laois, Ireland
| | - Eddie Murphy
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
- Health Service Executive, CHO 8 (Laois/Offaly), R32 YFW6 Laois, Ireland
| | - Laura K. Taylor
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
- School of Psychology, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Mark Shevlin
- School of Psychology, University of Ulster, Belfast BT1 6DN, UK;
| | - Louise McHugh
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
| | - Alan Carr
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
| | - Tom Burke
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (A.B.); (O.S.); (A.B.); (E.M.); (L.K.T.); (L.M.); (A.C.)
- School of Psychology, National University of Ireland, H91 CF50 Galway, Ireland
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Weiss M, Rostain A, Carson N, Gander S. Perspectives on the Pediatric Syndemic: Losses and Opportunities. WORLD SOCIAL PSYCHIATRY 2021; 3:73-76. [PMID: 38845743 PMCID: PMC11154590 DOI: 10.4103/wsp.wsp_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Affiliation(s)
- Margaret Weiss
- Director of Research for Child Psychiatry, Cambridge Health Alliance, Assistant Professor in Psychiatry Harvard Medical School, Cambridge MA, USA
| | - Anthony Rostain
- Chair, Psychiatry and Behavioral Health, Professor, Psychiatry and Pediatrics, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Nicholas Carson
- Medical Director for child and adolescent outpatient services, Cambridge Health Alliance, Assistant Professor in Psychiatry Harvard Medical School, Cambridge MA, USA
| | - Sarah Gander
- Clinical Department Head of Pediatrics, Assistant Professor Dalhousie University and Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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