Adverse Childhood Experiences, health insurance status, and health care utilization in middle adulthood

Womb to wisdom: Early-life exposure to midwifery laws and later-life disability

Previous research documented that midwifery service quality improvements lead to improving maternal and infants' health outcomes. However, little is known about its influence for later-life outcomes including disability. This paper explores the potential effects of early-life exposure to the establishment of midwifery laws across US states on later-life disability outcomes. Midwifery laws were enacted during the late 19th and early 20th century and required midwives to gain formal education and training to obtain a license in order to legally practice. We use decennial census data over the years 1970-2000 and implement a difference-in-difference method and show that being born in a reform state is associated with significant reductions in various measures of disability, including work disability, cognitive difficulty, ambulatory difficulty, self-care difficulty, and a proxy for severe mental health. We also find significant increases in education, socioeconomic scores, housing wealth, and income. We further discuss the policy implications of the results.

Characteristics and outcomes of medication-assisted treatment care models for pregnant women with opioid use disorder: A scoping review

BACKGROUND

Pregnant women and their unborn children are often overlooked in the opioid crisis, despite increased rates of both maternal complications and neonatal opioid withdrawal syndrome. Although medications for opioid use disorder (MOUD) are considered the gold standard for pregnant women, many either do not have access to or are not offered MOUD as an option.

OBJECTIVES

To describe the characteristics of MOUD care models and assess the effectiveness of MOUD Care Models on initiation, adherence, and engagement in treatment for pregnant women with OUD.

DATA SOURCES

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol directed the process of this scoping review. A search for English, peer-reviewed, quantitative studies, published between 2012 and 2023 was conducted in eight scholarly databases. The Joanna Briggs Critical Appraisal tools were used to assess study quality.

CONCLUSIONS

The integrated care models included medication management, psychotherapy support, behavioral health care, and medical care management, with added focus on prenatal and postpartum care. Synthesis revealed that treatment engagement, medication adherence, breastfeeding rates, and postdelivery MOUD referrals were higher in integrated care models compared with nonintegrated care models. Pregnant women with OUD in integrated care models have better outcomes compared with those in nonintegrated care models.

IMPLICATIONS FOR PRACTICE

Improvements in care models are necessary to tackle provider shortages, stigma, and financial, geographic, and technological barriers. Addressing these issues will enhance nurse practitioners' ability to provide comprehensive and accessible care to this vulnerable population.

Adverse childhood experiences, resilience, and syringe services program attendance among persons who inject drugs in Northeast Georgia, USA: A mediation analysis

Background

Syringe services programs (SSP) are evidence-based venues offering harm reduction services to persons who inject drugs (PWID), such as sterile syringes, STI/HIV testing, and linkage to care to decrease drug use-related morbidities and mortalities. Adverse childhood experiences (ACEs) have been linked with reduced resilience, while increased resilience can help PWID attend SSPs. This study examined the potential mediating role of resilience between ACEs and SSP attendance among PWID.

Methods

Data were collected from adult HIV-negative PWID in northeast Georgia, between February-December 2023 (N = 173). Data were collected on SSP attendance (Yes vs. No), resilience, and ACEs. Covariates included age, gender, sexual orientation, race/ethnicity, education, homelessness, HIV risk behavior, syringe sharing, syringe use frequency, and primary drug. Path analysis was performed using Stata 18.0.

Results

The majority of PWID were cisgender men (68.8 %), heterosexual (92.5 %), homeless (93.6 %), had HIV risk behavior (65.9 %), had high resilience (54.3 %), and had never attended SSP (64.2 %). The mean number of ACEs was 4.1 (SD=3.2). After adjusting for covariates, high resilience was positively associated with SSP attendance (β= 0.204; p = 0.005). ACEs were negatively associated with high resilience (β= -0.035 p = 0.005) and SSP attendance (β= -0.026; p = 0.034). ACEs had a significant indirect effect on SSP attendance through high resilience (β= -0.007; p = 0.044).

Conclusions

Results indicate that resilience may mediate the relationship between ACEs and SSP attendance among PWID. It is important to develop and implement trauma-informed and resilience-based interventions to address the mental and sexual health challenges of PWID with a history of ACEs.

Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019-2020

OBJECTIVES

To estimate the prevalence of adverse childhood experiences (ACEs) among a population-based sample of adults in the United States by their primary source of health care.

BACKGROUND

Debate continues around the effectiveness and implementation of health care-based screening of ACEs. However, it is unclear how the burden of ACEs would be distributed across different sources of health care (ie, what a health system might expect should it implement ACEs screening).

METHODS

Data are from 8 U.S. states that include optional modules for ACEs and health care utilization in their 2019 or 2020 Behavioral Risk Factor Surveillance System survey. The analytic sample includes respondents with completed interviews (n = 45,820). ACEs were categorized into ordinal categories of 0, 1, 2, 3, or ≥4; and the prevalence of ACEs was summarized across 5 sources of health care: (1) employer-based or purchased plan; (2) Medicare, Medicaid, or other state programs; (3) TRICARE, Veterans Affairs, or military (ie, military-related health care); (4) Indian Health Service; or (5) some other source. All estimates were weighted to account for the complex sampling design.

RESULTS

Across all health insurance types, at least 60% of individuals reported at least one ACE. The greatest prevalence of patients reporting ≥4 ACEs occurred for military-related health care (21.6%, 95% CI = 18.2-25.5) and Indian Health Service (45.4%, 95% CI = 22.6-70.3).

CONCLUSIONS

ACEs are extremely common across sources of health care, but some health systems have greater proportions of patients with high ACE exposures. The unique strengths and challenges of specific health care systems need to be integrated into the debate about clinical ACEs screening.

Life-Stage and Contextual Factors of Advance Care Planning Among Older Adults With Limited Income

Patient perspectives are essential to understand healthcare disparities such as low rates of advance care planning (ACP) among adults with limited income. We completed twenty semi-structured interviews using purposive and snowball sampling. Initial and final themes emerged from inductive inclusion of recurring codes and deductive application of the cumulative disadvantage theory. Four themes emerged: (1) structural, (2) life-stage, (3) social stressors and resources, and (4) individual stress responses and ACP readiness. ACP resources among participants included positive structural and social support and previous familial death experiences that were mitigated by stress avoidance and competing priorities. Structural resources and healthcare stressors should be addressed with policy and research to improve continuous healthcare participation and support early, comprehensive ACP.

Years of education mediate the association between adverse childhood experiences and unintended pregnancy: A population-based study in Japan

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with unintended pregnancies, including mistimed pregnancies (MP) and unwanted pregnancies (UWP). However, it remains unknown which cluster of ACEs (i.e., child maltreatment/household dysfunction and deprivation/threat) are associated with MP/UWP and whether years of education mediate these associations.

OBJECTIVE

To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years.

PARTICIPANTS AND SETTING

A retrospective cohort study among 7652 postpartum women in Chiba, Japan.

METHODS

MP/UWP was defined by emotional responses to confirming pregnancy. Multinomial logistic regression analyses with multiple imputed datasets estimated the relative risk ratio (RRR) of MP/UWP by cumulative scores and each cluster of ACEs. Causal mediation analysis assessed the indirect effects of years of education.

RESULTS

Women with 4 or more ACEs were at a 2.4 times higher risk of MP (95 % confidence interval (CI): 1.6-3.8) and a 5.0 times higher risk of UWP (95 % CI: 3.1-8.2). Among ACE clusters, having 3 or more household dysfunction showed the strongest association with MP (RRR: 1.91, 95 % CI: 1.23-2.95), and having 3 or more deprivation showed the strongest association with UWP (RRR: 3.69, 95 % CI: 2.00-6.83). Education years mediated 16 % and 11 % of the association between total ACEs and MP/UWP, respectively, with a similar trend observed in each cluster.

CONCLUSIONS

Not only ACEs score but also each cluster of ACEs was associated with MP and UWP. The mediating effects of years of education were modest.

Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

OBJECTIVE

Research demonstrates that adverse childhood experiences (ACEs)-that is, experiences of abuse, neglect, and household dysfunction-are related to lower preventive dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and preventive dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental cleaning and dental care utilization during pregnancy among a sample of women who delivered live births in North Dakota and South Dakota.

METHODS

Data are from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) in North Dakota and South Dakota (n = 7391). Multiple logistic regression is used to examine the relationship between the number of ACEs (0, 1, 2, 3 or 4 or more) and dental cleaning during pregnancy.

RESULTS

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.757, 95% CI = 0.638, 0.898). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

CONCLUSIONS

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental cleaning during pregnancy among women who delivered a live birth in North Dakota and South Dakota. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental cleaning during pregnancy and replicate the findings in other geographic contexts.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Juvenile Violent Victimization and Adult Criminal Outcomes: The Role of Military Service as a Turning Point in Young Adulthood

Previous research has consistently shown that juvenile violent victimization is associated with an increased risk of future criminal involvement, a phenomenon commonly known as victim-offender overlap. Despite a growing interest in the factors underlying this overlap, potential roles of major life transitions and turning points that may interrupt and reshape the nature of this developmental association have garnered less academic attention. Analyzing nationally representative data from waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 10,205), this study investigates the association between juvenile violent victimization and adult criminal outcomes (i.e., violent offending, non-violent offending, arrest, and incarceration) and whether this association is moderated by military service with and without combat experience in young adulthood. Employing a series of logistic regression analyses and adjusting for a host of covariates, measures of selection, and criminogenic traits, we found that juvenile violent victimization was significantly associated with greater odds of violent offending, arrest, and incarceration in adulthood. Among individuals with violent victimization histories, military service with no combat experience was associated with a 16% decrease in the odds of incarceration in adulthood. Combat experience, however, was associated with over seven times greater odds of violent offending in adulthood for these individuals. These findings have important implications for theory, research, and practice, and highlight the relevance of life transitions and turning points in general, and military service in particular, in mitigating or perpetuating the criminogenic impacts of violent victimization in the life course.

Previous Incarceration, Health Insurance, and the Affordable Care Act in the U.S

INTRODUCTION

This study examines the association between prior incarceration and health insurance status and whether living in a state adopting the Affordable Care Act (ACA) Medicaid expansion moderates this relationship.

METHODS

Data are from the National Longitudinal Study of Adolescent to Adult Health (Wave I [1993-1994], Wave IV [2008], and Wave V [2016-2018]; N=8,965). Multiple logistic regression with multiplicative interaction terms were performed to assess the relationship between previous incarceration and ACA Medicaid expansion on (1) being insured and (2) being on public health insurance. Analyses were performed in 2023.

RESULTS

Findings demonstrate a positive and statistically significant interaction in the association between previous incarceration and living in a state with ACA Medicaid expansion on having public health insurance (OR=2.402; 95% CI=1.257, 4.588).

CONCLUSIONS

The ACA Medicaid expansion was associated with a greater likelihood of public health insurance coverage for formerly incarcerated persons in the U.S. These findings suggest that Medicaid expansion could be critical in improving health insurance coverage among formerly incarcerated individuals who are a population that is more likely to be uninsured.

Adverse Childhood Experiences and Dental Care Utilization During Pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

Background

Research demonstrates adverse childhood experiences (ACEs)-i.e., experiences of abuse, neglect, and household dysfunction-adversely impact healthcare utilization over the life course. Several studies demonstrate that ACEs are related to lower dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental care utilization during pregnancy.

Data

Data are from the 2017-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) North Dakota and South Dakota (n = 7,391). Multiple logistic regression is used to examine the relationship between the number of ACEs and dental care utilization.

Findings

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.745, 95% CI = .628, .883). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

Conclusions

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental care utilization in adulthood, and this relationship is concentrated among White and Native American respondents. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental care utilization and replicate the findings in other geographic contexts.

A window of opportunity: Adverse childhood experiences and time alone with a provider in the United States

BACKGROUND

To date, there is limited literature on the relationship between Adverse Childhood Experiences (ACEs) and the quality of health care provider encounters. This is key, as people with a history of ACEs have a greater burden of illness.

METHODS

This study uses data from the 2020-2021 National Survey of Children's Health to examine relationships between ACEs and (1) spending less than ten minutes with a health care provider, and (2) spending time alone with a health care provider.

RESULTS

In general, our results suggested most ACEs were associated with higher odds of a provider spending <10 min with a child during their last preventative care visit, while ACEs were inconsistently related to spending time alone with a provider. Each additional ACE was found to be associated with higher odds of both outcomes.

CONCLUSIONS

This work emphasizes the importance of ACEs screening in a health care setting and may set the groundwork for future research investigating mechanisms within these associations. Given the established link between health care quality and patient-provider trust, and health outcomes, intervention work is needed to develop healthcare practices that may encourage the length and quality of health care provider visits.

Adverse Childhood Experiences and Cardiovascular Disease Risks: Implications for North Carolina and the Need for an Upstream Approach

Adverse childhood experiences (ACEs) have a negative impact on people across the lifespan, including poorer health outcomes. Data have indicated that 60% of North Carolina adults have experienced at least one ACE, while concurrently heart disease is the leading cause of death. There is a need to study the linkages between the two, and researchers and leaders should take an upstream approach to doing so.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020

OBJECTIVES

This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy.

METHODS

This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression.

RESULTS

The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503).

CONCLUSION

Exposure to three or more ACEs are associated with a higherrisk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.

Adverse Childhood Experiences and Cardiovascular Risk among Young Adults: Findings from the 2019 Behavioral Risk Factor Surveillance System

Background: Heart disease is the fourth leading cause of death for young adults aged 18-34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a contemporary, national sample to examine the association between ACEs and cardiovascular health among young adults in the United States, as well as potential mediating pathways. Methods: The present study uses data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine associations between ACEs and cardiovascular risk, as well as the role of cumulative disadvantage and poor mental health in these associations. Results: Findings indicate that young adults who have experienced a greater number of ACEs have a higher likelihood of having moderate to high cardiovascular risk compared to those who have zero or few reported ACEs. Moreover, both poor mental health and cumulative disadvantage explain a significant proportion of this association. Conclusions: The present findings suggest that young adulthood is an appropriate age for deploying prevention efforts related to cardiovascular risk, particularly for young adults reporting high levels of ACEs.