The Relationships Between Adverse Childhood Experiences, Patient-Centered Communication, and Care-Seeking Intention

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

1.110 Marijuana Use in Adverse Childhood Experience (ACE)-Exposed Young Adults and the Mediating Effect of Family Environment

Research on adverse childhood experiences (ACEs) often reports lower prevalence among Asian Americans compared to other racial and ethnic groups. However, most studies fail to account for the socioeconomic inequality and cultural heterogeneity in Asian American populations, which may influence the prevalence of ACEs and positive childhood experiences (PCEs). This study compared exposures to ACEs and PCEs among Asian American emerging adults (18-25years) from three ethnic groups: Asian Indian, Chinese, and Hmong and examined factors associated with disparities in ACEs and PCEs. A total of 814 Asian American emerging adults self-identified as Asian Indian, Chinese, or Hmong Americans were recruited online. Participants completed online surveys measuring ACEs (Philadelphia ACE Survey), PCEs (Benevolent Childhood Experience scale), and childhood socioeconomic position (CSEP). Overall, 58.9% of participants reported exposures to four or more ACEs. Hmong participants reported significantly more ACEs and fewer PCEs than Asian Indian participants (ACE score, p < .001; PCE score, p = .005) and Chinese participants (ACE score, p < .001; PCE score, p < .001). CSEP factors accounted for some of the variations in the disparities of ACEs and PCEs among the three ethnic groups. ACEs and PCEs were prevalent in this diverse sample of Asian American emerging adults. Significant disparities in ACE and PCE exposures across the three ethnic groups highlight the importance of accounting for Asian ethnicity and CSEP in future studies.

Background: Many studies demonstrated the relationship between adverse childhood experiences (ACEs) and diminished health functioning in adulthood. A growing literature has shown that positive childhood experiences (PCEs) co-occurring with ACEs reduce the risks for negative outcomes. Objective: The aim was to investigate how ACEs and PCEs are simultaneously associated with health outcomes in adulthood, including self-rated health, physical and mental health outcomes, and health-risk behaviours. Methods: A panel sample of 4,847 Slovenian adults was used and the data were weighted to closely resemble the Slovenian population. A series of logistic regression analyses were performed to examine how ACEs and PCEs predict the risk of various health outcomes. Results: Significant associations, as measured by adjusted odds ratios, were found between higher ACEs exposure and each of the 16 health outcomes evaluated. Adjusting for above median PCEs attenuated the association between ACEs and 6 health outcomes (poor self-rated physical and mental health, depression, anxiety, suicide attempt, physical inactivity; OR for ≥ 4 vs. 0 ACEs, 1.48–9.34). Mirroring these findings, above median PCEs were associated with lowered odds of these 6 health outcomes after adjusting for ACEs (OR for above vs. below median PCEs, 0.46–0.67), but not with odds of physical health outcomes and most of the health-risk behaviours. Stratified analyses by ACEs exposure level showed that the association between PCEs and self-rated health remained stable across ACEs exposure levels, while the association between PCEs and mental health outcomes and physical inactivity varied across ACEs exposure levels. Conclusions: Our results suggest that above median PCEs attenuate the association between ACEs and poor self-rated health, mental health problems, and physical inactivity in later life, and are negatively associated with these health problems even in the concurrent presence of ACEs. Interventions to promote PCEs can help to reduce unfavourable long-term health outcomes following childhood adversity.

Association of adverse and positive childhood experiences with subjective age: findings from 5759 Chinese young adults.

Clinical communication focused on childhood adversity has not been well described in the extant literature. There is a wealth of knowledge about patient-centered communication, including patient-centered communication techniques involving the discussion of health risks in primary care. However, there remain gaps in our understanding of the role that communication plays in exploring adverse childhood experience (ACE) exposure among adults in the clinical context. To better understand factors that influence how nurse practitioners (NPs) communicate with adults about ACEs in the context of primary care while simultaneously exploring NPs' perceptions and experiences of their ability to communicate with adults about ACE exposure. Guided by the Patient-to-Provider Communication of Adverse Childhood Experiences in Primary Care (PPC-ACE) Model, an exploratory, qualitative, descriptive study was conducted among 15 US-based primary care NPs. Nurse practitioner's participated in semistructured interviews, which were recorded and transcribed. Transcripts were analyzed using inductive thematic analysis. Atlas.ti provided supplemental data visualization. Demographic data, practice characteristics, and baseline ACEs knowledge were collected by means of Qualtrics. Key themes described communication approaches and perceived barriers and facilitators to ACE-related conversations. Scope of practice, provider biases, diversity in practice models, and secondary trauma were factors NPs' perceived as positively or negatively influencing ACE-related communication in primary care. Outcomes from this study provided deeper insights into the various influencers of NP-perceived, ACE-related, patient-centered communication among adults in primary care. Findings will inform future research focused on ACE-related communication in primary care in the domains of NP education, practice, and health policy.

The dose-response relationship of adverse childhood experiences (ACEs) with chronic morbidities is recognized as prevalent. However, screening for ACEs and implementing trauma-informed care (TIC) have yet to become a standard of care in pediatrics. To document impactful developmental experiences of implementing TIC and universal screening of ACEs in the pediatric setting, elucidate the relationship between ACEs and their common presentation of developmental and behavioral health problems in pediatric patients, and propose feasible system changes to promote evidence-based professional expertise. During pediatric residency training, I implemented routine universal screening of pediatric patients using ACE questionnaires. Research-based trauma-informed practices, such as patient-centered communication regarding adverse health outcomes associated with prevalent ACEs, were used. Clinical vignettes describe 12 cases. Most patients and their families were receptive to counsel on recognizing, preventing, and mitigating the effects of toxic stress resulting from ACEs. Behavior in a patient, and sometimes a parent, was addressed from a developmentally sensitive lens of TIC, and appropriate therapeutic interventions were discussed. Addressing ACEs opened crucial conversations with some patients, which promoted efficacious, developmentally sensitive care. Implementing TIC in the pediatric setting, especially in training, is not only feasible but also vital to adequately understand the patient population. Equipped with clinical knowledge and experience in addressing ACEs, practitioners will more readily empower patients and their families to improve health outcomes. When pediatric practitioners discover, intervene, and address the adverse effects of ACEs, their care becomes more efficacious and evidence based.

Adverse childhood experiences (ACEs) are traumatic events that occur in a child's life between birth and 18 years. Exposure to one or more ACE has been linked to participation in risky health behaviors and the experience of chronic health conditions in adulthood. The risk for poor outcomes increases as the number of ACEs experienced increases. This research investigates rural-urban differences in exposure to ACEs using a sample from a representative southern US state, South Carolina. Using data from the 2014-2015 South Carolina Behavioral Risk Factor Surveillance System &#40;BRFSS&#41; and residential rurality based on UICs, ACE exposure among South Carolina adults was tabulated by urban versus rural residence and selected other demographic characteristics. Using standard descriptive statistics, frequencies and proportions were calculated for each categorical variable. Multivariable regression modeling was used to examine the impact of residential rurality and selected sociodemographic characteristics on overall and specific types of ACE exposure. All analyses used survey sampling weights that accounted for the BRFSS sampling strategy. The analytic sample of 18 176 respondents comprised 15.9% rural residents. Top reported ACEs for both rural and urban residents were the same: parental divorce/separation, emotional abuse, and household substance use. Compared to urban residents, a higher proportion of rural respondents reported experiencing no ACEs (41.4% vs 38.3%, p<0.01). The prevalence of four or more ACEs in rural respondents was 15.0%; in comparison, 17.6% of urban respondents had four or more ACEs (p<0.01). In logistic regression predicting exposure to four or more ACEs and adjusting for sex, age, race/ethnicity, education, and income, rural respondents were less likely than urban respondents to report four or more ACEs (adjusted odds ratio 0.75, 95% confidence interval 0.74-0.75). Despite reporting less ACE exposure than urban counterparts, almost 60% of rural residents reported at least one ACE and 15% reported experiencing four or more ACEs. In contrast to urban residents, rural residents may experience more social connections within their families and communities, which may influence ACE exposure; however, care coordination, social support services, and access to health care are limited in rural areas. Thus, families in rural areas may be less equipped to mitigate and manage the effects of ACEs. Findings from this study thus suggest that interventions to prevent ACE exposure are just as needed in rural southern communities as they are in urban southern communities. Topics important for future research could include an examination of ACEs in rural communities in terms of individuals' health outcomes and their access to health care, as well as the role of protective factors. Programs and policies that assist in ACE prevention in rural areas are important to reducing these multigenerational threats to health and wellbeing.

Clustering of adverse and positive childhood experiences: The nature and correlates of risk and protective factors

Introduction: Adverse childhood experiences (ACEs) are severe psychosocial stressors that occur during the first 18 years of life and are associated with impaired vascular endothelial function (VEF). Augmented mitochondrial reactive oxygen species (mtROS; i.e., superoxide) production contributes to oxidative stress and vascular dysfunction. Purpose: Therefore, we tested the hypothesis that young adults with (ACE+) versus without (ACE-) prior ACE exposure would be associated with augmented mtROS in association with reduced in vivo VEF. Methods: We used two different cohorts of young adults without cardiometabolic disease and different, but complementary models to test our hypothesis. In Study 1 (n=17; age = 23±3 years; BMI = 22±4 kg/m2), peripheral blood mononuclear cells were isolated from whole blood and T-cell mtROS was assessed by flow cytometry with fluorogenic staining (MitoSOX Green) and presented as median fluorescence intensity [MFI; arbitrary units (AU)]. T cell subtype frequency, T cell mtROS, and FMD in ACE- and ACE+ were compared with independent samples t-tests. Using an ex-vivo cell culture model in Study 2 (n=23; age = 24±5 years; BMI = 26±5 kg/m2), human aortic endothelial cells (HAECs) were cultured with 10% participant serum before fluorescent probe staining with CellROX for 30 minutes. Live HAECs were imaged using fluorescence microscopy and total mtROS was assessed. Total mtROS and FMD in ACE- and ACE+ were compared with independent samples t-test. In both studies, in vivo VEF was assessed using the brachial artery flow mediated dilation (FMD) technique and associations between mtROS and FMD were examined using Spearman’s correlation coefficients (ρ). Results: In Study 1, the frequency of T-helper (CD4+), total regulatory T (Treg), T-cytotoxic (CD8+) cells of total live T cells were not different between groups (all p &gt; 0.49). However, T-helper (8477±564 AU vs 9337±654 AU, p = 0.011) and Treg (8635 ± 729 AU vs 9557 ± 746 AU, p = 0.021) mtROS was lower in ACE+ than ACE-, whereas the difference in T-cytotoxic (CD8+) mtROS was not significant ( p = 0.08). In Study 2, mtROS produced by HAECs was lower in the ACE+ group compared to the ACE- group (1285±121 AU vs 1416±127 AU, p = 0.019). In both Study 1 and 2, FMD was lower in ACE+ than ACE- (-4.2±1.3%, p = 0.007 and -3.4±1.2%, p &lt; 0.01, respectively). Interestingly, there were moderate, non-significant, positive associations of T-helper (ρ = 0.46, p = 0.066) and Treg mtROS (ρ = 0.42, p = 0.098) with FMD in Study 1, and a significant positive association of endothelial mtROS with FMD (ρ = 0.50, p = 0.016) in Study 2. Conclusions: Our findings from two separate cohorts using different, but complimentary approaches provide strong initial evidence that ACE exposure is associated with counterintuitive reductions in mtROS production in both endothelial and T-cells. The use of the ex-vivo cell culture model suggests that this effect may be driven by, as of yet, unidentified factor(s) in circulation. Funding: Supported by NIH and AHA funding to NDMJ (R01HL167788, L30HL149066, &amp; 24TPA1290435) and to DRS (R01AG066730). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Adverse childhood experiences (ACEs) are life events that occur before the age of 18. ACEs can lead to toxic stress and development of negative health behaviors and chronic diseases, especially for ≥4 ACEs. Current research primarily focuses on adult ACEs. The interaction between parent ACEs and their children’s subsequent health is poorly studied. This study assessed parent and children ACE exposure on presentation to our burn unit and their impact on burn recovery. Children presenting to the burn unit were enrolled. Parents completed a self-report ACE-18 survey. ACE-18 questions included parent ACEs and child ACEs. Parents completed a strengths and needs survey and parent resiliency questionnaire. Follow-up surveys, including child depression screening (DSM-V) and Burn Outcome Questionnaire (BOQ), were completed at 1–3 months post-injury. Baseline analysis comparing the number of child ACEs (0 ACE and ≥1 ACE) or ages (<5 years and ≥5 years) were performed using SPSS 25.0. Significance was assumed at <0.05. Sixty-nine children were enrolled. The average age was 5.3 ± 5.0 years (63.8% <5 years). Most were male (57%) and white (77%). The average total burn surface area was 4.1 ± 5.2%. Parents reported a mean of 2.4 ± 2.9 ACEs for themselves and 1.3 ± 1.8 ACEs for their children. A correlation was observed between parent ACE exposure and child ACE exposure (r = 0.57; p = 0.001). Children ≥5 years were more likely to have more ACEs (2.1 ± 2.6 vs. 0.8 ± 0.9; p = 0.0025) and parents with more ACEs (3.9 ± 3.9 vs. 1.5 ± 1.6; p = 0.0005). Average family needs were 2 ± 2.2; 46.4% reported 2 or more needs, including food insecurity (15.9%), housing insecurity (7.2%), and imprisonment of a household member (5.8%). Family needs were higher for families of children with ≥1 ACE (2.4 ± 2.4 vs. 1.3 ± 1.8; p = 0.042) and of children ≥5 years (3.0 vs. 1.4; p = 0.04). Older children were more likely to present with flame (p = 0.03) or flash burn-related injury (p = 0.006). Thirty-four participants (49.3%) completed follow up at 1–3 months post-injury (50.9 ± 22.5 days). Besides less male participants (47%), the follow-up population was comparable to the overall population. Most children presented with no signs of depression (88 to 100% depending on the questions), acceptable pain (86%) and were active (95%). Our data suggest that families of burned children and children themselves, especially those ≥5 years, present with an ACE burden and a significant number of needs and negative social determinants of health. The strength of ACE assessment may be in preventing future trauma and health consequences. This understanding may enable health care providers to engage patient strengths and take into consideration their needs when devising a care plan to bring the child to a healthier life.

Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis

Children with intellectual disabilities experience unique developmental, social, and environmental challenges that intersect with adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), shaping their psychosocial outcomes. While prior research has mainly examined single adversities or protective elements, the frameworks of ACEs and PCEs provide a broader understanding of their cumulative and interactive effects. However, these constructs remain underexplored in children with intellectual disabilities. This scoping review maps the range, conceptualization, and impact of ACEs, PCEs, and related concepts on psychosocial outcomes. Following the Joanna Briggs Institute (JBI) methodology, a search of PsycInfo, MEDLINE, CINAHL, Web of Science, and Google Scholar identified studies until October 2024. Two reviewers screened and extracted data using standardized criteria. Findings reveal variability in how ACEs and PCEs are defined and measured. ACE exposure, particularly the cumulative impact of multiple ACEs (polyvictimization), links to adverse psychosocial outcomes, including emotional (e.g., anxiety, depression, Post-Traumatic Stress Disorder), behavioral (e.g., aggression, conduct problems), and developmental (e.g., social and adaptive skill deficits) difficulties. PCEs—such as positive parent–child relationships, teacher–student support, and peer acceptance—mitigate risks, though impact varies by context. Intellectual disabilities severity and socioeconomic adversity shape associations. Further research is needed to inform the adaptation of ACE–PCE frameworks for children with intellectual disabilities.

BackgroundAdverse childhood experiences (ACEs) increase the risk of poor health outcomes later in life. Psychosocial stressors may also have intergenerational health effects by which parental ACEs are associated with mental and physical health of children. Epigenetic programming may be one mechanism linking parental ACEs to child health. This study aimed to investigate epigenome-wide associations of maternal preconception ACEs with DNA methylation patterns of children. In the Center for the Health Assessment of Mothers and Children of Salinas study, cord blood DNA methylation was measured using the Illumina HumanMethylation450 BeadChip. Preconception ACEs, which occurred during the mothers’ childhoods, were collected using a standard ACE questionnaire including 10 ACE indicators. Maternal ACE exposures were defined in this study as (1) the total number of ACEs; (2) the total number of ACEs categorized as 0, 1–3, and > 4; and (3) individual ACEs. Associations of ACE exposures with differential methylated positions, regions, and CpG modules determined using weighted gene co-expression network analysis were evaluated adjusting for covariates.ResultsData on maternal ACEs and cord blood DNA methylation were available for 196 mother/newborn pairs. One differential methylated position was associated with maternal experience of emotional abuse (cg05486260/FAM135B gene; q value < 0.05). Five differential methylated regions were significantly associated with the total number of ACEs, and 36 unique differential methylated regions were associated with individual ACEs (Šidák p value < 0.05). Fifteen CpG modules were significantly correlated with the total number of ACEs or individual ACEs, of which 8 remained significant in fully adjusted models (p value < 0.05). Significant modules were enriched for pathways related to neurological and immune development and function.ConclusionsMaternal ACEs prior to conception were associated with cord blood DNA methylation of offspring at birth. Although there was limited overlap between differential methylated regions and CpGs in modules associated with ACE exposures, statistically significant regions and networks were related to genes involved in neurological and immune function. Findings may provide insights to pathways linking psychosocial stressors to health. Further research is needed to understand the relationship between changes in DNA methylation and child health.

Introduction: Adverse Childhood Experiences (ACEs) are used as an indicator of childhood trauma. Two-thirds of the United States population has experienced at least one ACE. Research indicates there is a relationship between ACEs and unhealthy behaviors, such as smoking and physical inactivity, that increase one’s risk for cardiovascular diseases. Very few studies have analyzed how ACEs impact dietary patterns, another risk factor for cardiovascular disease, increasing the risk for hypertension (HTN). This study aimed to explore how the number of ACEs experienced relates to dietary intake and HTN in an adult population in California. Hypotheses: We hypothesized that ACEs will have a negative effect on dietary intake and that ACEs will increase the risk for HTN. Methods: We conducted a cross-sectional analysis using 2020 California Health Interview Survey data. This sample included 21,463 participants, who were US adult citizens and California residents. To assess ACEs, HTN, and dietary intake, we utilized the ACE scale and survey items measuring self-reported HTN and fruit and vegetable intake. Study data was analyzed using chi-square tests, analysis of variances, and multinomial logistic regressions in STATA v.18. Results: Study participants were majority female (57%), White (64%), and an average age of 52.5. Over 22.5% of the study participants reported four or more ACEs. Participants ate around nine fruits and nine vegetables per week. About one-third (32.09%) of study participants had been diagnosed with HTN, with another 8% being diagnosed with borderline HTN. The analysis revealed a relationship between HTN and ACEs [x 2 (8) = 16.12 p=0.041]. The analysis found a statistically significant association stating those with no ACEs ate more fruits and vegetables than those with 4+ ACEs (p = .002). There was a significant association between experiencing four or more ACEs with sex, age and race (p &lt; .01). Conclusions: The study findings indicated that having four or more ACEs is associated with poorer diet and risk of HTN in adults. The findings from this study may help inform future research about ACEs' and their impact on diet in adults. Our study also explored how covariates such as race, gender, and age are correlated with experiencing ACEs. Researchers can use these findings to create specific interventions for individuals with ACEs, focusing on how improving dietary patterns can be used to reduce the risk of poor cardiovascular outcomes.