“There are a million and one other ways to punish someone than sending them away…” Exploring the impact of having a family member in prison on children and young people’s health and emotional wellbeing – A qualitative longitudinal study

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

Adverse childhood experiences (ACEs) are associated with young people’s criminal legal system involvement, but the extent to which distinct types of ACEs and positive childhood experiences (PCEs) differentially relate to arrests and convictions for youth is unknown. We identified childhood exposures that remain independently associated with arrests and convictions by age 26 among a broad set of ACEs and PCEs. We conducted a cross-sectional analysis of data from two components of the nationally representative Panel Study of Income Dynamics. We examined the occurrence and number of arrests and convictions by age 26 and constructed ACE- and PCE-type indicator variables and overall scores. Weighted, covariate-adjusted logistic and negative binomial regression models estimated associations between ACE types and arrests and conviction outcomes, controlling for PCE score. Similarly, we estimated PCE-type outcome associations controlling for ACE score. Finally, we examined sex differences and stratified results by race. Of 7,200 participants, 14.9% were arrested by age 26. Controlling for PCE score, physical abuse and parental divorce/separation were associated with both arrests and convictions. Arrests were also associated with sexual abuse and parental substance use. Convictions were also associated with emotional abuse and parental mental health problems. Experiencing more PCEs was protective against arrest. We found sex differences for children experiencing sexual abuse. Certain ACEs appear more closely linked to young people’s risk of arrests and convictions, while combined PCE types may be protective. Interventions and policies that target these specific ACEs and boost PCEs may help disrupt pathways into the criminal legal system.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation

Adverse Childhood Experiences: Research, Effects, and Tools for Change

Objective: Adverse Childhood Experiences (ACEs) are traumatic exposures such as abuse, neglect, and household challenges that occur in childhood, and are associated with numerous psychiatric and cardiovascular conditions in adulthood. An expanded list of ACEs accounting for community-level stressors like experiences of racism, witnessing violence, bullying, foster care, and living in unsafe neighborhoods, have also been associated with poor health outcomes decades later. Black men may face structural inequities that increase the risk of exposure to ACEs, while also facing disparities in both cardiovascular health (CVH) and mental health outcomes. Despite these disproportionate risks, research examining household, family and community-level ACEs remain understudied in Black men. Given the importance of mental wellbeing to cardiovascular health, understanding how childhood adversity affects mental health warrants more study, particularly in Black men with unideal cardiovascular health. Methods: 149 Black men with low or moderate cardiovascular health participating in a community-based lifestyle intervention study, Black Impact, were surveyed for conventional ACEs, expanded ACEs, and validated measures of depressive symptoms, perceived stress, and social/emotional well-being. Linear regression models examined how ACEs predicted mental health measures. Logistic regression models examined ACEs’ effect on the odds of reaching clinically significant depression. Results: Each additional ACE was significantly associated with greater depressive symptoms, perceived stress, and social isolation, as well as lower emotional wellbeing and social functioning. An ACE score ≥ 4 was associated with 459% increased odds of reaching clinically significant depression (OR 4.59, 95% CI: 1.62 – 12.95) compared to 0-3 ACEs. Family and household-level ACEs were associated with all mental health measures. Community-level ACEs were associated with depressive symptoms, perceived stress and emotional wellbeing, but they were not associated with social functioning and social isolation. Conclusion: Increased ACEs predicted worse mental health symptoms across all measures in a sample of Black men with low or moderate cardiovascular health. Next steps include assessing the relationship between ACEs exposure and lifestyle intervention outcomes and exploring how to interrupt ACE-health outcome pathways to mitigate mental health and CVH disparities among Black men.

ABSTRACTIntroductionFamilial imprisonment is one of ten recognised adverse childhood experiences (ACE), with established long‐term impacts on health, care and wellbeing. Where safe and appropriate, the right of a child to protect and maintain family life (and therefore visit and/or remain in contact with a family member in prison) is protected in the United Nations Convention on the Rights of the Child (UNCRC). Despite this, families face many barriers when visiting prison, and children and young people's experiences of doing so, in their own words, are less widely reported.MethodsDrawing on serial longitudinal interviews and the curation of creative methods with 19 children and young people (age 7–16) who have a family member in prison across Northern England and Scotland, the aim of this study was to explore the impact of familial imprisonment on children and young people's health and wellbeing, and to utilise our findings to develop a rights‐based framework for prison social visits.ResultsReflexive thematic analysis identified three intersecting themes: (1) navigating complex, adult systems; (2) distress, grief and trauma; (3) acceptance, normalisation and coping mechanisms. In this paper, we illustrate how these themes were harnessed to co‐produce a child‐centred framework for social visits based on children and young people's priorities for change, a framework we articulate as ‘The Three Cs’.ConclusionContact, which strengthens family ties and protects health and wellbeing, requires approaches which are child‐centred, consistent and compassionate. Crucial to this are enhancements to prison officer mandatory training on family ties and the impact of family imprisonment as well as exploration of how to harness existing support pathways designed for vulnerable children and young people to ensure that those experiencing familial justice‐involvement do not fall through gaps in service provision.Patient or Public ContributionFrom its inception, this project was a partnership between academia and two voluntary sector organisations that support families experiencing imprisonment with the core project team being split between academic and practice‐based partners (reflected in this article's authorship). An international stakeholder group was also convened to support the study across its duration and who supported the research team in the development of research questions, topic guides and participant materials, guided the interpretation of our findings, and provided input into our impact and dissemination strategy. This group met quarterly and included representation from voluntary sector and grassroots organisations, academics with experience of working with children, families and justice‐involved populations, prison and probation service colleagues and creative practitioners. Aligned with this partnership approach, we established regular satellite check‐ins with other voluntary sector organisations across the United Kingdom who support families experiencing imprisonment to embed relationality and feedback loops for actionable change. Five study participants were involved in the co‐creation of comics, illustrated by Jack Brougham (see ‘Materials and methods’ section for further insight). Finally, during the analysis, dissemination and impact phases of the project, we worked with a youth board of children with experience of familial imprisonment (recruited through a partner organisation) to sense‐check our findings and to develop a campaign video (an approach chosen by the board). The video was based on the analysis of project data and the youth board's own experiences. This process was held over 3 full‐day sessions, co‐facilitated by a locally based arts organisation and involved a range of creative activities. Participants were thanked for their time with gift vouchers. Both processes with young people (data collection and engagement activity) further informed our analysis and were fundamental to shaping our three Cs framework, a framework co‐produced with our core voluntary sector partners and illustrated by Nifty Fox.

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

ObjectivesBilateral oophorectomy has commonly been performed in conjunction with hysterectomy even in women without a clear ovarian indication; however, oophorectomy may have long-term deleterious consequences. To better understand this surgical...

Background: Adverse childhood experiences (ACEs) have been identified as an important public health problem with serious implications. Less well understood is how distinct configurations of childhood adversities carry differential risks for mental health, emotional, and social outcomes later in life. Objective: To determine if distinct profiles of childhood adversities exist for males and females and to examine if unique associations exist between the resultant latent profiles of childhood adversities and multiple indicators of mental health and social and emotional wellbeing in adulthood. Method: Participants (N = 1,839) were a nationally representative household sample of adults currently residing in the USA and the data were collected via online self-report questionnaires. Latent class analysis was used to identify the optimal number of classes to explain ACE co-occurrence among males and females, separately. ANOVAs, chi-square tests, and t-tests were used to compare male and female classes across multiple mental health, emotional, and social wellbeing variables in adulthood. Results: Females were significantly more likely than males to report a range of ACEs and mental health, social, and emotional difficulties in adulthood. Two- and four-class models were identified as the best fit for males and females, respectively, indicating more complexity and variation in ACE exposures among females. For males and female, ACEs were strongly associated with poorer mental health, emotional, and social outcomes in adulthood. Among females, growing up in a dysfunctional home environment was a significant risk factor for adverse social outcomes in adulthood. Conclusions: Males and females have distinct patterns of childhood adversities, with females experiencing more complex and varied patterns of childhood adversity. These patterns of ACEs were associated with numerous negative mental, emotional, and social outcomes among both sexes.

This study explores the narrated lived experiences of Military-Connected Children and Young People (MCCYP) in Denmark and examines the relationship between Adverse Childhood Experiences (ACEs) and Benevolent Childhood Experiences (BCEs), particularly in the context of parental combat-related PTSD within their told stories. Using content analysis, interview data was re-analysed using the Adverse Childhood Experiences (ACEs) and Benevolent Childhood Experiences (BCEs) questionnaires to identify ACEs and BCEs within the captured narrative data. The initial study where the data was captured examined military children’s experiences and the impact of a five-day residential camp on well-being, resilience, and self-esteem, based on co-constructed meaning between participants and researchers, with ethical approval ensuring parental consent and participant assent. Ten young people (aged 12–19, mean = 15.00, SD = 2.54) attended the Denmark-based camp run by Støt Soldater & Pårørende (SSOP), a charity supporting children of veterans. Six were female, four males, and all had at least one parent with a self-reported PTSD diagnosis. The findings show that most participants (nine out of ten) had a parent with PTSD, leading to an average ACE score of 2.7. These challenges included physical or emotional abuse, living with a parents who has poor mental health, witnessing domestic violence and having a parent abuse substances. Despite these challenges, all participants reported key protective factors, contributing to an average BCEs score of 4. The protective factors included feeling safe with a caregiver, having external support, and experiencing home stability. The study discusses the implications for clinical practice, proposing the ICE (Identify, Connect, Engage) model for Trauma-Informed Care (TIC), which focuses on early identification of adversities, building trust through compassionate connection, and involving MCCYP in decision-making. The study underscores the importance of letting stories breathe to considering both the adversities and resilience factors in MCCYP narratives, advocating for a holistic, child-centred approach to supporting their health and well-being.

Adverse childhood experiences (ACEs) are associated with depression and systemic inflammation in adults. However, limited longitudinal research has tested these relationships in children and young people, and it is unclear whether inflammation is an underlying mechanism through which ACEs influence depression. We examined the longitudinal associations of several ACEs across different early-life periods with longitudinal patterns of early-life inflammation and depression in young adulthood and assessed the mediating role of inflammation. The data came from the Avon Longitudinal Study of Parents and Children (N = 3931). ACEs from the prenatal period through to adolescence were operationalised using cumulative scores, single adversities, and dimensions derived through factor analysis. Inflammation (C-reactive protein) was measured on three occasions (9–18 years) and depressive symptoms were ascertained on four occasions (18–23 years). Latent class growth analysis was employed to delineate group-based trajectories of inflammation and depression. The associations between ACEs and the inflammation/depression trajectories were tested using multinomial logistic regression analysis. Most types of ACEs across all early-life periods were associated with elevated depression trajectories, with larger associations for threat-related adversities compared with other ACEs. Bullying victimisation and sexual abuse in late childhood/adolescence were associated with elevated CRP trajectories, while other ACEs were unrelated to inflammation. Inflammation was also unrelated to depression and did not mediate the associations with ACEs. These results suggest that ACEs are consistently associated with depression, whereas the associations of inflammation with ACEs and depression are weak in young people. Interventions targeting inflammation in this population might not offer protection against depression.

Paper 1 Abstract. Objectives: Childhood adversity is a risk factor for the development of obesity in adulthood. ❧ Dysregulated hypothalamic-pituitary-adrenal (HPA) activity, which has been associated separately with both adverse childhood experiences and obesity, has been posited as a mechanism by which stressful experiences influence body mass index (BMI); however, this mechanism has not yet been tested longitudinally. The present study uses multi-reporter, longitudinal data across three time points to test whether the adolescent cortisol awakening response (CAR), an index of diurnal HPA activity, mediates the association between adversity in childhood and BMI in adulthood. ❧ Methods: 82 youth, mothers, and fathers reported on adverse childhood experiences from middle childhood to late adolescence. During adolescence, youth provided saliva samples three times each morning across three days, which were assayed for cortisol to calculate CAR. During early adulthood, youth reported height and weight to calculate BMI. ❧ Results: Greater adversity predicted flatter CAR and higher young adult BMI. Flatter CAR partially mediated the association between childhood adversity and young adult BMI. ❧ Conclusions: Stress-related alterations to HPA activity account in part for the childhood adversity-adult obesity link. Findings are consistent with theoretical models implicating HPA alterations as linking childhood adversity to metabolic and behavioral determinants of BMI in adulthood. ❧ Paper 2 Abstract. Family of origin aggression (FOA) exposure is a chronic childhood stressor that has been linked to altered stress reactivity of the hypothalamic pituitary adrenal (HPA) axis in adulthood. Effects of FOA also spill over between partners in romantic couples, such that one partner’s FOA history influences the other’s HPA reactivity during couple interactions. However, the direction of these effects is inconsistent, with both heightened and blunted HPA reactivity observed; this heterogeneity suggests the presence of moderators. The present study measures HPA reactivity during emotionally vulnerable conversations between young adult romantic partners to assess whether romantic attachment avoidance accounts for this divergence by moderating actor- and partner-effects of FOA on HPA. One hundred-twelve opposite-sex couples (224 young adults) provided information on FOA and avoidance, completed dyadic interaction procedures, and provided saliva samples to assess HPA reactivity during interactions. Multi-level structural equation models revealed that FOA did not predict either own or partner’s HPA reactivity. However, FOA and avoidance interacted to produce both actor- and partner-effects, such that greater FOA exposure heightened HPA reactivity when avoidance was high but blunted reactivity when avoidance was low. Results support that proximal relationship-related characteristics, such as attachment avoidance, influence whether distal relationship-related stressors, such as FOA, amplify or attenuate physiological reactivity during emotionally vulnerable interactions. As HPA reactivity has been linked to a variety of health outcomes, identifying relationship-related buffers of associations between FOA and HPA response may inform future interventions to protect health for FOA-exposed youth. ❧ Paper 3 Abstract. Growing up in an aggressive family confers health risk life-long. However, less is known about how the romantic relationships young adults form may contribute to trajectories from family of origin aggression (FOA) to disease. The present study assesses whether health effects of FOA can be detected as early as young adulthood in a community sample, whether hypothalamic-pituitary-adrenal (HPA) axis reactivity during interactions with romantic partners mediates these associations, and whether this risk mechanism depends on young adults’ levels of romantic attachment avoidance. Eighty-five opposite sex couples reported on FOA and attachment avoidance, engaged in dyadic interaction tasks while providing saliva samples to index HPA reactivity, and had at least one partner complete a follow-up health visit. Inflammation was indexed by two pro-inflammatory cytokines: interleukin-1β (IL-1β) and interleukin-6 (IL-6). Results indicate that FOA is associated with greater IL-1β and IL-6 for men. The indirect effect of men’s FOA on IL-1β through HPA reactivity was conditional on men’s levels of attachment avoidance, such that greater FOA only conferred heightened reactivity for more avoidant men; heightened reactivity, in turn, predicted greater IL-1β. Low attachment avoidance buffered men from the total effect of FOA on IL-1β. No indirect or conditional indirect effects were detected for men’s IL-6. No predictors were associated with women’s inflammation. By identifying how attachment amplifies or attenuates risky health trajectories, we take an exploratory step toward identifying how young adults’ relationships can serve both as a disease mechanism and as a natural point of intervention.

This systematic review synthesized current knowledge about the prevalence of adverse childhood experiences (ACEs) among young people known to have offended and examined evidence of associations between ACEs, trauma symptoms, and offending behavior. A systematic search of English-language, peer-reviewed studies published from the year 2000 onwards was conducted. A final pool of 124 studies that reported quantitative data were included in the review. The Cambridge Quality Checklist for the assessment of studies on offending was used to assess methodological quality of included studies. Pooled data indicated that almost 87% of justice-involved young people across 13 countries experienced at least one traumatic event. The odds of experiencing at least one ACE were over 12 times greater for justice-involved young people compared with nonjustice-involved young people. Prevalence of individual ACEs ranged from 12.2% for childhood sexual abuse to 80.4% for parental separation among justice-involved young people. Those who reported both a higher number and multiple types of ACEs were more likely to be diagnosed with post-traumatic stress symptoms. However, when considering only high-quality studies, there was minimal evidence to suggest that a higher incidence of ACEs predicted trauma symptoms or that trauma symptoms mediated the association between ACEs and offending behavior. Further research is needed to elucidate factors that differentiate young people exposed to ACEs who go on to offend from those who do not. This research is essential to understanding whether ACEs and trauma are drivers of offending behavior and for informing prevention and intervention strategies.

Introduction: Adverse Childhood Experiences (ACEs) are stressful life events that are associated with an increased risk of depression. Depression is experienced by 25% of cancer survivors in the US. While previous studies have examined the associations between ACEs and depression in the general population, studies on cancer survivors are lacking. We aimed to examine the predictors of depression with a primary focus on ACEs among cancer survivors. Methods: Using a cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System for 19,241 cancer survivors aged 18 and above, we categorized ACEs based on severity. The ACE categories (zero, one, two-three, ≥four) included questions assessing exposure to eight types of ACEs before age 18 years. The outcome is self-reported history of depression diagnosis (yes/no). Weighted multivariable logistic regression models estimated odds of depression by ACEs as the primary variable and covariates were age, gender, smoking status, income, education, marital status, body mass index, health status and race. Results: In this sample of cancer survivors, 41%, 22%, 21% and 16% reported having experienced zero, one, two-three, and >4 ACEs respectively. Personal history of depression was reported by 21% of survey respondents. In the adjusted model, survivors with 1 ACE (aOR: 1.6, 95% CI. 1.2- 2.0), 2-3 ACEs (aOR: 1.7, 95% CI. 1.3- 2.1), or >=4 ACES (aOR: 4.4, 95% CI. 3.4- 5.7) had higher odds of depression compared with those with zero ACEs. Additional notable predictors of higher odds of depression are younger age, 18-39 (aOR: 2.7, 95% CI. 1.8- 4.0), middle age, 40-64 (aOR: 1.6, 95% CI. 1.3- 1.9) compared with those aged 65 and older; females (aOR: 2.1, 95% CI. 1.7- 2.5) compared with males; obese respondents (aOR: 1.5, 95% CI. 1.2- 1.9) compared with respondents with normal body mass index; current smokers (aOR: 1.5, 95% CI. 1.2- 2.0) compared with respondents who never smoked; and poor or fair health status (aOR: 3.2, 95% CI. 2.6- 3.9) compared with respondents with excellent/good health status. Conclusion: Adult cancer survivors who experience ACEs as children represent an important targeted prevention group to reduce risk of depression. Variation by age, obesity, female gender, current smoking status, and poor health associated factors that may reduce the risk of depression warrants additional studies regarding potential for identification of resilient factors; and this may inform future selective prevention strategies, as well as identify a pathway between ACE and depression among cancer survivors. Citation Format: Oluwole Adeyemi Babatunde, Vince Collucielli, Melanie S. Jefferson, Swann Arp Adams, Chanita Hughes Halbert, Jessica Obeysekare, Frank Clark, Anusuiya Nagar, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Adverse childhood experiences and history of depression among cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 825.

The Risky Family Model postulates that adverse childhood experiences (ACE) are likely to be encountered across generations within custodial grandfamilies which, in turn, may adversely impact their overall well-being. The present study is a pioneering attempt to examine the patterns of ACEs self-reported by custodial grandmothers (CGM) and adolescent grandchildren (AGC) from the same families, and how their total ACE scores correlate with key physical and mental health outcomes. A total of 129 CGM-ACG dyads recruited for a nationwide RCT study completed separately at baseline the 10-item ACE-CDC and 4 items from the ACE-IQ, as well as various standardized measures of physical and emotional well-being. The most frequent ACEs reported by AGC were loss of a parent (60.5%), verbal abuse (58.1%), bullying by peers (46.5%), and living with someone jailed (45.0%). The predominant ACEs for CGM were bullying by peers (48.8%), verbal abuse (48.1%), living with a mentally ill person (34.1%), being touched sexually (29.5%), and loss of parent (29.5%). Only 10.1% of ACG and 15.5% of CGM reported 0 ACEs, whereas 65.1 % of ACG and 59% of CGM reported > 3 ACEs. For ACG, total ACE scores correlated significantly with externalizing (r=.32) and internalizing (r=.30) difficulties, self-esteem (r= -.28), loneliness (r=.27), school problems (r=.24), and physical health (r= -.26). For CGMs, anxiety (r=.23) and depression (r=.19) only were correlated significantly with total ACEs. We conclude that although both CGM and ACG reported alarmingly high levels of ACEs, different patterns and correlates exist between the generations. [Funded by R01AG054571]