Adverse Childhood Experiences Scores Research Articles

A hypothetical intervention to reduce inequities in anxiety for Multiracial people: simulating an intervention on childhood adversity.

Multiracial people report higher mean Adverse Childhood Experiences (ACEs) scores and prevalence of anxiety than other racial groups. Studies using statistical interactions to estimate racial differences in ACEs-anxiety associations do not show stronger associations for Multiracial people. Using data from Waves 1 (1995-97) through 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we simulated a stochastic intervention over 1,000 resampled datasets to estimate the race-specific cases averted per 1,000 of anxiety if all racial groups had the same exposure distribution of ACEs as Whites. Simulated cases averted were greatest for the Multiracial group, (median = -4.17 cases per 1,000, 95% CI: -7.42, -1.86). The model also predicted smaller risk reductions for Black participants (-0.76, 95% CI: -1.53, -0.19). CIs around estimates for other racial groups included the null. An intervention to reduce racial disparities in exposure to ACEs could help reduce the inequitable burden of anxiety on the Multiracial population. Stochastic methods support consequentialist approaches to racial health equity, and can encourage greater dialogue between public health researchers, policymakers, and practitioners.

Adverse Childhood Experiences, Women Who Are Sex Trafficked, and Social Service Utilization: Implications for Social Work.

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings.

ACE Scores and STI Rates Among Pregnant and Postpartum Persons at a University Hospital [ID 2683476

INTRODUCTION: Sexually transmitted infections (STIs) have increased across the United States. Universal screening for HIV, hepatitis B, hepatitis C, and syphilis is recommended each pregnancy. Risk-based screening is recommended for chlamydia, gonorrhea, and trichomonas. Adverse childhood experiences (ACEs) quantify exposure to adverse events at age less than 18 years and are associated with risky sexual behavior. Little is known about ACEs and risk of STIs. Risk-based STI screening utilizing ACE score has the potential to improve STI diagnosis and treatment in pregnancy. METHODS: This is a retrospective observational cohort study of pregnant and postpartum persons who underwent ACE scoring from 2015 to 2019. High ACE score was greater than or equal to 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with cervicitis (gonorrhea, chlamydia, and/or trichomonas positive) and any STI positive (gonorrhea, chlamydia, trichomonas, HIV, syphilis, and/or HSV positive). RESULTS: Adverse childhood experience scores were available for 808 participants. 44% had Medicaid/no insurance. 71% reported White race, 28% Black, and 1.7% other. Mean ACE score was 2.9 (SD 2.5); 37% (n=300) had high ACE score. High ACE was associated with cervicitis (adjusted odds ratio [aOR] 1.762; 95% CI, 0.886–3.503) and any STI positive (aOR 1.187; 95% CI, 0.776–1.815), but not significant. CONCLUSION: Persons with high ACE scores were not more likely to have cervicitis or any STI positivity despite previous studies demonstrating an association to risky sexual behaviors. Our small sample size may contribute to the lack of a statistically significant association. More research is needed to determine if ACE score can be utilized in risk-based STI screening.

Relationship Between High ACE Score, HIV Risk Behavior, and Previous HIV Testing in the South Carolina BRFSS [ID 2683384

INTRODUCTION: The incidence of human immunodeficiency virus (HIV) in the United States is stable among women. Due to stigma, 13% of persons with HIV are unaware of their diagnosis. Adverse childhood experiences (ACEs) describe negative events during childhood using a standardized questionnaire. Limited data exist on how ACEs affect HIV screening. Utilizing state-collected data from the Behavioral Risk Factor Surveillance System (BRFSS), we assessed the relationships between high ACE, gender, HIV risk behaviors, and previous HIV testing. METHODS: This is a retrospective observational cohort study of the BRFSS from 2014–2016 and 2019–2021. High ACE score was ≥ 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with HIV risk behaviors and previous HIV testing. RESULTS: Over 54,000 individuals were surveyed; 15% had high ACE scores. 4% reported HIV risk behaviors and 35% reported previous HIV testing. The mean ACE was 1.6 (SD 2.1). High ACE demonstrated increased risk of HIV risk behaviors (adjusted odds ratio [aOR] 2.652; 95% CI, 1.987–3.538) and previous HIV testing (aOR 2.340; 95% CI, 2.031–2.696). Female respondents were less likely to report HIV risk behavior (aOR 0.442; 95% CI, 0.336–0.581) and previous HIV testing (aOR 0.822; 95% CI, 0.736–0.919). CONCLUSION: Persons with high ACE scores were more likely to engage in HIV risk behaviors and have a history of HIV testing. Our findings suggest ACE scores may be useful for identifying persons at risk for HIV. The stable incidence of HIV and reduced perception of risk among women demonstrate the need for tailored HIV screening for women.

Cohort profile: the Adverse Childhood Experiences cohort of the Malawi Longitudinal Study of Families and Health

PurposeThe Adverse Childhood Experiences (ACE) cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-ACE) is a study of adolescents surveyed during 2017–2021. It provides an important opportunity to...

Differential effects of gender and ethnicity on children’s receptive language scores after a Canadian two-generation preschool program: follow-up to adolescence

ABSTRACT Preschool programs for socially vulnerable children are believed to affect school readiness and language development but infrequently include follow-up to adolescence; observational measurement of receptive vocabulary is rare. The purpose of this longitudinal cohort study (55 children and 41 parents) was to report the trajectory of receptive vocabulary development for socially vulnerable children of diverse ethnicities (Indigenous, other Canadian-born, and Immigrant) who participated in a two-generation preschool program. English receptive vocabulary scores were measured at 5-time points: (a) program intake, (b) program exit, (c) age 7 years, (d) age 10 years, and (e) adolescence, using the Peabody Picture Vocabulary Test – Third Edition (PPVT-III). For all children, PPVT-III scores increased the most between program intake and exit and positive changes were sustained until adolescence. When the sample was examined by gender, PPVT-III scores were higher for boys than girls at all time points. When the sample was examined by ethnicity, other Canadian-born children scored higher than Indigenous and Immigrant children at all time points. Immigrant children scored lowest until age 7 years, and at age 10 years and adolescence scored higher than Indigenous children. Using mixed-effects modeling, PPVT-III scores increased when English was the primary language spoken at home at intake. PPVT-III scores increased slightly as caregiver age and caregiver Adverse Childhood Experiences score increased. PPVT-III scores were lower for Immigrant girls and Indigenous boys than other sub-groups of children. Differential effects of the two-generation preschool program by gender and ethnicity suggest tailoring programming to increase equitability of receptive vocabulary development for immigrant girls and Indigenous boys. Children with intergenerational adversity may require additional support.

Association Between Adverse Childhood Experiences and Academic Performance Among Children and Adolescents: A Global Meta-Analysis.

This study was conducted to quantify the association of adverse childhood experiences (ACEs) and the academic performance of children and adolescents. The literature was systematically searched in six electronic databases, and a meta-analysis was conducted. Twenty studies with a total of 1,196,631 children and adolescents from five countries were included. Meta-analysis showed that ACE score was positively associated with poor academic achievement, grade repetition, and special education support. Compared with children and adolescents without any ACE, those with one or more ACE had a significantly higher risk of poor academic achievement (pooled odds ratio [OR]: 1.45, 95% confidence interval [CI] [1.13, 1.85], I2 = 82.6%) and grade repetition (pooled OR: 1.36, 95% CI [1.29, 1.43], I2 = 71.0%). Moreover, all types of ACEs were positively associated with poor academic achievement and grade repetition. In addition, there was a significant dose-response relationship between the ACE score and the risk of poor academic achievement. This study supported that ACE had a significant impact on the academic performance of children and adolescents. Based on these findings, we recommend that early screening of ACEs for children and adolescent is critical and appropriate support and prevention in education should be developed for those with ACEs. Further studies are needed to further explore the long-term effect of ACEs on education and its gender differences.

Trends in the dose-response relationship between adverse childhood experiences and maladaptive metacognitive beliefs: A cross-sectional study

BackgroundSince the publication of the major research on adverse childhood experiences (ACE) at the turn of the millennium, our knowledge about the prevalence and physical and mental consequences of childhood adversities has increased substantially. In parallel, research on metacognition, which plays an important role in understanding our mental functioning, has also been on the rise. Although the adverse effects of ACEs on mental processes and the role of metacognitive deficits in the development of mental disorders are widely known, hardly any research into the interaction between these two areas has been conducted; this is what triggered our investigation. MethodsOur research was carried out as a cross-sectional study on a sample of 304 members of the general population. We measured ACEs with the 10-item Adverse Childhood Experiences Questionnaire and maladaptive metacognitions—positive and negative metacognitive beliefs, cognitive confidence, cognitive self-consciousness, and need to control thoughts— using the Meta-Cognitions Questionnaire.The closeness of the relationship between the ACE score and metacognitions was measured using Pearson's linear correlation coefficient, while the association of ACE accumulation with metacognitive beliefs was assessed using generalized linear models. ResultsThe most common ACE in our sample turned out to be emotional neglect (44.74%). All the examined maladaptive metacognitive beliefs correlate mildly to moderately with the number of suffered ACEs (r = 0.13–0.34), with an increase in the ACE score leading to a rise in the salience of maladaptive metacognitive beliefs. Moreover, a dose-response relationship was seen between increases in ACE scores and the overall values of metacognition, negative metacognitive beliefs, and the maladaptive metacognitive belief of the need to control thoughts. ConclusionsOur results suggest that the more ACEs were experienced in childhood, the more pronounced the dysfunctional metacognitive beliefs are. Therefore, our findings emphasize the importance of further research into the topic.

Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women.

Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups. This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups. A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach's alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE's theoretical structure and Pearson's correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW. The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square (χ2) = 14.26, degrees of freedom (df) = 9, p = 0.113, minimum discrepancy (CMIN/df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00-0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW. This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.

The Effect of Physical Activity and ACE Scores on Psychological vs. Physiological Addiction

Brianna N. Hendershot, Chelsea L. Robertson, Ryan T. Koenig, Jason W. Metz West Liberty University, West Liberty WV. Abstract Addiction is a growing problem in the United States. Rehabilitation facilities have exercise as a component of their program, yet these facilities are not always within reach of every addict. Understanding that addiction is a chronic disease that is treatable with integrated treatment methods, it’s imperative to find the root of addictive tendencies. PURPOSE: To determine if there is a triangular relationship between addiction, physical activity, and adverse childhood experience (ACE) scores, looking specifically at psychological and physiological addiction types. METHODS: Data was collected from 25 females and 6 males, recruited from West Liberty University via email. Subjects completed a self-reported online anonymous 4-section survey including basic demographics, The International Physical Activity Questionnaire-Short Form (IPAQ-SF), The Health-Resiliency-Stress Questionnaire Part D (HRSQ), and addictive tendencies through questions regarding the criteria for psychological and physiological addiction from the DSM. A moderation analysis was used to triangulate the relationship between vigorous exercise, ACE scores, and addiction scores. RESULTS: The moderation variable was vigorous exercise from the past 7 days and ACE scores. Psychological and physiological addiction were correlated at .477, p=0.835, and .590, p=0.097, respectively. Total addiction produced a correlation of .574, p=0.241. CONCLUSION: A moderation analysis revealed no significant data when looking at vigorous exercise, ACE scores, physiological addiction, psychological addiction, and total addiction, showing the need for future research in this field. Looking at specific addictive behaviors objectively may aid in finding the root of addictive tendencies.

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data.

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth. Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data. Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups. This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Relationship between parental adverse childhood experiences and the prevalence of early childhood caries.

The aim of this study was to examine the behavioural health conditions associated with parents' retrospective adverse childhood experiences (ACEs) scores and their children's early childhood caries (ECC) in parent-child dyads. Parents with children younger than 72 months were included in the study. A relational screening model was used. Interaction among ACEs, ECC, nutritional habits and oral hygiene habits were evaluated. Chi-square tests and t-tests were used in the study. Multiple variables were evaluated using the artificial neural network (ANN) model. The mean age of the 535 children included in the study was 46.5 months, and 52% were female. Using the ANN model, there was a statistically significant relationship between the educational status of the mothers in both the ECC and severe ECC (S-ECC) groups and the socioeconomic status of the family (p < 0.05). If the number of snacks consumed daily was three or more, the risk of ECC was statistically significantly higher (chi-square test p = 0.034). The parents' ACEs scores had an impact on both ECC and S-ECC formation (p = 0.001, t-test). The higher the ACEs score, the higher the risk of S-ECC. The mean ACEs scores of the parents were also significantly higher in both the ECC and S-ECC groups compared to those of the parents of children without dental caries (p = 0.001, t-test). It was calculated that ACEs scores were effective at a rate of 18.2% on ECC (p = 0.045, ANN). The ACEs scores of parents have an impact on the oral health of young children and ECC/S-ECC formation. The long-term effects of parental ACEs are reflected in their children's oral health. Therefore, reducing the psychosocial determinants ACEs and providing parental support may help in overcoming barriers to the well-being of young children and may facilitate better oral health.

초기 성인의 아동기 부정적 경험과 자살사고

The purpose of this research was to determine whether depression plays a mediating role between adverse childhood experiences(ACEs) and suicidal ideation and to examine whether social ecological resilience had moderated mediating effects. The study model was designed based on PROCESS v.3.5 for SPSS by Hayes. A total of 309 samples was selected for the study, which consisted of adults aged 18 to 28 years old, and data was collected through a survey for the analysis. The main findings of this study are as follows : First, depression had a partial mediating effect in the relationship between ACEs Score and suicidal ideation. Second, social ecological resilience moderated the mediation effect of depression between ACEs and suicidal ideation. The results indicate that suicidal ideation in early adulthood was reduced by strengthening social ecological resilience. Thus, it would be useful to apply the social ecological resilience model to intervene the influence of ACEs on suicidal ideation in early adulthood.

Nutrition Knowledge, Food Insecurity, and Adverse Childhood Experiences Among Underserved College Students

An online, cross-sectional survey examined food insecurity, adverse childhood experiences, academics, health status, dieting, and associations with nutrition knowledge among 83 freshmen Educational Opportunity Program university students in California. Mean (SD) nutrition knowledge was 13.6 (5.0) out of a perfect score of 29. Most students (84%) reported being food secure. The median adverse childhood experiences score was 1.00 (interquartile range, 0.00-3.00), an indication of intermediate risk for toxic stress, and the mean (SD) high school grade point average was 3.62 (0.38) out of 4. More adverse childhood experiences were associated with higher nutrition knowledge (P = .005). High school grade point average predicted nutrition knowledge (P = .003). The results may be helpful in designing larger, more representative studies of the Educational Opportunity Program population and finding helpful interventions.

Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio.

This study investigated whether insurance status and/or developmental disability moderated the association between adverse childhood experiences (ACE) and unmet dental needs among children aged 0 to 17 in Ohio. We utilized cross-sectional data from the 2021 Ohio Medicaid Assessment Survey to assess the dental needs of children. ACE scores, dental insurance status, and developmental disability status were analyzed using multivariable logistic regression to identify their potential association with parental-reported unmet dental needs. The weighted sample represented 2,752,222 children in Ohio. Over half reported zero ACEs (55.8%) and no dental needs (56.1%). Approximately 1 in 9 lacked dental insurance (11.1%), and 1 in 10 had a developmental disability (9.9%). Children with one to three ACEs had three times the odds of unmet dental needs compared to children with zero ACEs (OR = 3.20; 95%CI [2.10, 4.89]), and children with four or more ACEs had eight times the odds of unmet dental needs (OR = 8.78; 95%CI [5.26, 14.67]). Children lacking dental insurance had over six times higher odds of unmet dental needs compared to children with dental insurance (OR = 6.10; 95%CI [3.92, 9.49]). The presence of developmental disability status did not moderate the presence of unmet dental needs; however, the lack of dental insurance status significantly moderated the association between ACEs and unmet dental needs. Insurance status, not developmental disability, moderated the association between ACEs and unmet dental needs among children in Ohio. Efforts to ensure continuous access to dental insurance are warranted.

The association of adverse childhood experiences with household income, educational attainment and partnered status among adults aged 30-39

BackgroundThe association of adverse childhood experiences (ACEs) with young adult social outcomes is poorly understood. ObjectiveTo examine the relationship between ACEs and young adult household income, education, and partnered status. Participants13,767 respondents (population-weighted estimate N = 13,191,291) aged 30–39 completed the optional ACES module in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) from 17 states. MethodsThe 2019 BRFSS was used to analyze the significance of ACE scores for the likelihood of reporting household income greater than $75,000, a college or postgraduate degree, and living with a partner among respondents aged 30–39. Poisson regression analyses controlled for sociodemographic, health status, and behavioral risk characteristics. ResultsAs compared to those with zero ACEs, respondents reporting four or more ACE exposures (20.2% of respondents) were marginally less likely to report high income (IRR: 0.87, 95% CI: 0.79–0.97) and one-third less likely to report a college degree (IRR: 0.68, 95% CI: 0.61–0.76), with no significant difference in partnered status. ConclusionsYoung adult social status may be shaped by social-emotional effects of ACEs that go beyond demographic and health status differences. Enhancing resilience to childhood adversity can benefit from a trauma-informed approach in health care, education, and employment.

Medical student non-modifiable risk factors and USMLE Step 1 exam score

ABSTRACT For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23), females were 2.77 (1.06–7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023–2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026–2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process.

Can ICD-10 Z codes be used as proxy measures for ACE categories? – a proof of concept

ABSTRACT Objective The landmark study by Felitti showed adverse childhood experiences (ACEs) influence future health outcomes. This paper looks at the routine data collected in a Child and Youth Mental Health Service (CYMHS) related to contextual factors in the International Classification of Diseases (ICD-10 Z codes) and seeks to identify proxies for the ten original ACEs categories. In the absence of routinely collected ACE categories, these ICD-10 Z codes which could potentially act as ACE proxies would be helpful for clinical understanding and service delivery. Method ICD-10 Z codes collected routinely from 2108 individuals were analysed to identify Z codes which might serve as proxies for the ACE categories. To understand whether these Z codes were used appropriately during service delivery to indicate ACE categories, randomly selected files of patients having at least one of the above Z codes in their list of diagnoses were reviewed. Subsequently, the associations between several Z codes (serving as ACE proxies), demographic factors, and clinical outcome measures were explored. Results Significant differences were observed in terms of the mean ACE score of patients when sex, Indigenous status and certain diagnostic groups were considered. Similarly, when patient groups having exposure to different numbers of ACEs were compared, significant differences were observed in outcome scores (HoNOSCA and CGAS). Conclusion There is evidence that certain Z codes, can act as ACE proxies. This suggests a possible utility of this method in studying other associations and possibly helping to tailor future therapeutic interventions.

Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community.

Childhood adversity is associated with chronic pain in adulthood. Additionally, individuals identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report a greater prevalence of chronic pain and increased adverse childhood experiences (ACEs). While the LGTBQ+ community has a disproportionately high chronic disease burden, limited research has been conducted on the associations between chronic pain conditions or intensity and childhood adversity in this population. In this cross-sectional study, participants were 18 years or older, LGBTQ+ identifying, and reported chronic pain. Surveys were electronically distributed from August to November 2022 via LGBTQ+ organization email listservs and social media platforms. The survey included demographics and validated questionnaires measuring chronic pain (The Chronic Pain Questionnaire) and childhood adversity (ACE score). In analysis, ACE scores of 4 or more were defined as high. Responses from 136 individuals (average age of 29 ± 7.4 years) were analyzed. The mean for participants' average pain rating in the last 6 months was 5.9 of 10. Participants' worst pain was rated at least a 7 of 10 for 80% of respondents. Half (47%) had high ACE scores, and high ACE scores were significantly associated with higher average pain scores (6.27 ± 1.79, mean difference = -2.22, P = .028, 95% confidence interval [CI], -1.2 to -0.0), and higher perceived current pain ratings (4.53 ± 2.16, mean difference = -2.78, P = .007, 95% CI, -1.9 to -0.3). Transgender and gender diverse (TGD) participants (n = 75) had higher ACE scores (3.91 ± 1.78) and current pain scores compared to cisgender individuals (3.9 ± 1.8 vs 3.0 ± 1.9, P = .009, 95% CI, 0.0-0.3). History of any sexual trauma was prevalent in 36.7% and was associated with chronic pain located in the pelvic region (P = .016, effect size estimate 0.21). Specific histories of forced sexual and touch encounters were associated with a specific diagnosis of fibromyalgia (P = .008, effect size estimate 0.31 and P = .037, effect size estimate 0.31, respectively). Childhood adversity and chronic pain's dose-dependent relationship among our LGBTQ+ sample indicates a need to explore trauma's role in perceived pain. Given sexual trauma's association with pain location and diagnosis, type of trauma may also be crucial in understanding chronic pain development. Research into the relationships between childhood adversity, sexuality, gender identity, and chronic pain could improve chronic pain prevention and management for the LGBTQ+ community.