Race and sex differences in adverse childhood experiences among Asian/Pacific Islander college students

Prevalence and associated factors of adverse childhood experiences (ACE) in a sample of Brazilian university students

BACKGROUND

Adverse childhood experiences (ACEs) have long been associated with health risk behaviors, but they are poorly studied in Brazilian university students.

OBJECTIVE

To estimate the prevalence of ACEs and investigate their association with sociodemographic data, health risk factors and self-related health in a sample of university students.

PARTICIPANTS AND SETTING

A cross-sectional study conducted with 546 students from a Brazilian public university.

METHOD

The self-reported 10-ACE Study questionnaire (ACE-Q) and sociodemographic information (age, sex, family income), health risk factors (body mass index, physical exercise, alcohol and tobacco use) and self-related health were assessed. Chi-square Test and multivariate logistic regression were used to evaluate the association between the cumulative occurrence of ACE (ACE ≥4) and the studied factors.

RESULTS

Of the 546 participants, 464 responded to all ACE-Q questions; 74.4% reported at least one ACE, and 13.1 % reported four or more. Lower family income (OR = 2.02; 95%CI = 1.13-3.61; p = 0.01) and self-related poor health (OR = 2.29; 95%CI = 1.28-4.08; p = 0.00) were associated with the occurrence of ACE ≥4.

CONCLUSION

Most students reported at least one ACE, while a minority reported ≥4 ACEs associated with lower family income and poor self-health. The data suggest that preventive actions should be considered to mitigate the problem, with lower-income students being treated as a priority.

Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma

BACKGROUND

Adverse childhood experiences (ACEs) are prevalent, impact long-term physical and mental health, and are associated with eating disorders (EDs) in adulthood. The primary objectives of the current study were: (1) to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults, (2) to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED, (3) to statistically classify ACEs profiles using latent class analysis, and (4) to examine associations between ACEs profiles and diagnosis.

METHODS

This cross-sectional study assessed patients with a DSM-5 ED receiving treatment between October 2018 and April 2020 at the inpatient, residential, or partial hospitalization levels of care at one of two private ED treatment facilities. ACEs were assessed with the Adverse Childhood Experiences Survey at admission. Generalized linear models and Welch's t-tests were used to compare ACEs in the current sample with national estimates. A latent class analysis was conducted to examine subgroups of ACEs responses, and differences in these classes by ED diagnoses were examined with multinomial logistic regression.

RESULTS

Patients with EDs had significantly higher ACEs scores (M = 1.95, SD = 1.90) than the nationally representative sample (M = 1.57, SD = 4.72; t = 6.42, p < .001). Within patients with EDs, four latent classes of ACEs item endorsement were identified. Patients with other specified feeding or eating disorder (OSFED) and binge eating disorder (BED) were more likely to fall into the "Household ACEs" and "Abuse ACEs" groups, respectively, compared to anorexia nervosa-restricting subtype (AN-R).

CONCLUSIONS

Patients with EDs reported more ACEs than the nationally representative sample, and differences in total ACEs and latent class membership were found across ED diagnoses. The current study can inform the development of trauma-informed care for patients with EDs.

The Implementation of Screening for Adverse Childhood Experiences in Pediatric Primary Care

OBJECTIVE

To assess the implementation of screening, screening rates, and prevalence of adverse childhood experiences (ACEs) in a large integrated healthcare system.

STUDY DESIGN

Kaiser Permanente Southern California is a large integrated healthcare system with 15 medical centers/hospitals and 233 medical office buildings that serve approximately 1.5 million children. Screening for ACEs began in July 2018 at 1 medical center (Downey, Bellflower medical office) for 3- and 5-year-old well-child visits (yearly physical examination). It quickly expanded to 3 other medical centers (6 clinics in total) and now also includes the 10- and 13-year-old well-child visits.

RESULTS

Since July 2018 we have screened 3241 3-year-olds (53% of the target population), 2761 5-year-olds (53%), 545 10-year-olds (37%), and 509 13-year-olds (13%). Of the 3-year-olds who were screened, 15% had an ACEs score of 1 or higher. Of the 5-year-olds that were screened, 17.5% had an ACEs score of 1 or higher. Of the 10-year-olds, 30.5% had an ACEs score of 1 or higher and of the 13-year-olds, 33.8% had an ACEs score of 1 or higher.

CONCLUSIONS

Although we have encountered some challenges, particularly with follow-up for those screening positive for ACEs, screening was feasible. The data show an increasing trend of ACEs in 3- to 13-year-old children, highlighting the need for early education about ACEs to mitigate the effects of toxic stress.