Adverse Childhood Experiences Exposure Research Articles

Exploring Independent and Cumulative Effects of Adverse Childhood Experiences on PTSD and CPTSD a Study in Ugandan Adolescents

Exposure to adverse childhood experiences (ACEs) is related to higher morbidity and mortality among adolescents. The present study analyzed the independent and cumulative effects of ACE exposure on the likelihood of PTSD and a CPSTD diagnosis in Ugandan adolescents. A sample of 401 schoolchildren participated in the study. The primary aim was to collect information on ACEs, PTSD, CPTSD, and attachment styles among adolescents living in different countries. It was found that exposure to 2–3 ACEs and exposure to 4–5 ACEs were significantly associated with PTSD diagnosis, while exposure to sexual abuse, bullying, threats of violence, and near-drowning were significantly related to CPTSD diagnosis. Fearful attachment style was significantly associated with PTSD diagnosis. The results propose that biological, psychological, and social issues interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study underscores the importance of addressing childhood-averse and traumatic experiences as a public health priority in Uganda.

Structural adverse childhood experiences associated with suicidal ideation, suicide attempts, and repetitive nonsuicidal self-injury among racially and ethnically minoritized youth.

High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots. Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety. Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures. Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

Adverse childhood experiences, individual-level risk and protective factors, and recent drug use in a community sample of Nigerian women.

Adverse childhood experiences (ACEs) are associated with a wide range of health problems and health-compromising behaviors, including drug use, but are understudied in sub-Saharan Africa. Further, some data suggest that some types of ACEs are more strongly associated with outcomes than others. We investigated associations between different types of ACEs and recent drug use among 2,011 women living in Katsina State, Nigeria. This community-based survey included questions on ACE exposure, modifiable individual-level risk and promotive factors, and past-year drug use. Tobacco, cannabis, and the nonmedical use of cough syrup with codeine and tramadol were the most frequently used drugs. Logistic regressions revealed that across most drugs, ACEs reflecting abuse, neglect, and household dysfunction, but not community violence, increased the likelihood of drug use, odds ratios (ORs) = 1.30-3.10. Ease of access to drugs, ORs = 1.33-2.98, and personal religiosity, ORs = 1.19-2.27, also enhanced the risk of drug use, and higher depressive affect was associated with codeine, OR = 1.27, and tramadol use, ORs = 2.42. Practicing religious rites, ORs = 0.38-0.70; disapproval of drug use, ORs = 0.36-0.57; and perceived harm from drug use, ORs = 0.54-0.71, reduced the likelihood of drug use. Efforts to prevent abuse, neglect, and household dysfunction; reduce access to drugs; treat depression; and increase disapproval and harm associated with drug use may reduce drug use in the context of ACE exposure.

Generational differences in latent classes of exposure to adverse childhood experiences

Adverse Childhood Experiences (ACEs) have increased across generations; however, it is unclear how ACE exposure clusters into classes and how exposure differs by generation. To examine this clustering, we used data from the 2019 Behavioral Risk Factor Surveillance Survey (n = 56,262). We identified ACEs exposure classes and examined the probability of belonging to each ACEs exposure class by birth generation, sex assigned at birth, race/ethnicity, and LGBTQ+ identity. We identified three ACEs exposure classes: Low ACEs, High ACEs without Sexual Abuse, and High ACEs with Sexual Abuse. Findings demonstrate that, relative to Baby Boomers, the probability of experiencing High ACEs without Sexual Abuse was 5 % higher for Gen X and 11 % for both Millennials and Gen Z. The probability of experiencing High ACEs with Sexual Abuse was highest for Gen X and lowest for Gen Z. Significant intersectional relationships were found between LGBTQ+ identity and both generation and sex assigned at birth. These findings have implications for health policy.

Placental Cortisol Dysregulation in Mothers with Experiences of Childhood Adversity: Potential Mechanisms and Clinical Implications.

Adverse childhood experiences (ACEs) are extremely prevalent in the United States population. Although ACEs occurs in childhood, exposure to them has been associated with adverse future pregnancy outcomes and an increased risk of poorer social determinants of health, which further drive the risk of negative pregnancy outcomes. In addition, maternal ACE exposure has been linked to poor infant and child outcomes, highlighting the intergenerational transmission of risk from mother to child. While alterations along the Maternal-Placental-Fetal Hypothalamic-pituitary-adrenal (HPA) axis is hypothesized to be involved, the exact biological pathway underlying this intergenerational passage of risk is mostly unknown. This present work will highlight what is known about pregnancy-related stress hormone physiology, discuss the potential mechanisms of action of ACEs on cortisol regulation, and suggest opportunities for further clinical and translational studies.

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.

Adverse Childhood Experiences and Diabetes Risk in Mississippi Adults.

Despite Mississippi's high diabetes prevalence and the growing literature finding significant associations between adverse childhood experiences (ACEs) and diabetes, no research has examined the relationship between ACEs and diabetes risk in Mississippiadults. This study utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) to determine if such a relationship existed. Data for Mississippi respondents were weighted to account for nonresponse bias and non-coverage errors. Each respondent's total ACE exposure score was calculated based on the number of ACE categories experienced. Multivariate logistic regression was utilized to model the relationship between diabetes and ACE categories and diabetes and total ACE exposure scores. Variables that were significant at p<0.05 were retained in the final (best-fitting) models. All models were adjusted for sex, age, race, level of education, income, and body mass index (BMI). After adjusting for covariates, those experiencing physical abuse (adjusted odds ratio (AOR) 1.72, 95% CI 1.69; 1.75) or sexual abuse (AOR 1.56, 95% CI 1.53; 1.58) had the highest odds of ever being diagnosed with diabetes. Experiencing one ACE (AOR 1.02, 95% CI 1.01; 1.03) was associated with slightly higher odds of having diabetes, while experiencing seven ACE categories (AOR 2.20, 95% CI 2.10; 2.31) had the highest odds. Overall, this study shows a strong association between ACEs and a diagnosis of diabetes in the state of Mississippi. This relationship represents an important focus area for prevention efforts in legislation, public health campaigns, and universal screening procedures in primary care that may decrease the prevalence and burden of diabetes in Mississippi.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe.

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Adverse childhood experiences and subsequent physical and mental health among young adults: Results from six universities in China

Research has shown that individuals with adverse childhood experiences (ACEs) are more likely to encounter heightened risks of physical and psychological challenges later in life. However, limited research has explored the comprehensive impact on the physical and mental health of young adults. Thus, we conducted a study to investigate the associations of ACEs with the physical and mental health of 18,723 college students in China. Their physical and mental health status was assessed using self-perceived health assessments, self-reported disease diagnoses, and the Generalized Anxiety Disorder-7-item scale. Results showed that 82.6 % of participants had experienced at least one ACE, with 10.7 % reporting exposure to four or more ACEs. Compared to participants with low ACEs exposure (≤ 1), participants with high ACEs exposure (≥ 4) had a nearly twofold increase in the odds of cardiometabolic diseases (OR [95 % CI] = 2.06 [1.55-2.74]) and fractures (2.32 [1.88-2.87]). Additionally, individuals with high ACE exposure exhibited a threefold increased odds of severe anxiety symptoms (3.78 [2.59-5.51]) and bipolar disorder/schizophrenia (3.38 [2.18-5.23]). These findings highlight ACEs as a significant risk factor for poor physical and mental health among young adults. Targeted support and interventions for individuals with multiple ACEs may help mitigate their long-term disease burden.

The transmission of intergenerational trauma and protective factors in survivors of the lebanese civil war and their adult offspring

BackgroundThe aim of the study was to examine the transmission of intergenerational trauma in survivors of the Lebanese civil war and their adult offspring. To examine potential mechanisms, it was hypothesized that the relationship between parental war exposure and offspring psychopathology was statistically mediated by (i) parental psychopathology and (ii) offspring exposure to adverse childhood experiences (ACE). Finally, it was predicted that spirituality and social support might buffer against the effects of adversity and therefore moderate the association between trauma exposure and psychopathology. MethodAn online questionnaire-based study was conducted, recruiting 110 dyads of parents who had lived through the Lebanese civil war and their post-war born adult offspring. Parental war exposure and trauma symptoms [with the Harvard Trauma Questionnaire (HTQ)] and offspring adverse childhood experiences and trauma symptoms [with Adverse Childhood Experiences International Questionnaire (ACE-IQ) and Impact of Events Scale Revised (IES-R)] were assessed. Both parents and offspring’s distress [with Beirut Distress Scale (BDS-10)], depression and anxiety symptoms [with Depression, Anxiety, and Stress Scale (DASS-21)], perceived social support [with Multidimensional Scale of Perceived Social Support (MSPSS)], and perceived spirituality [with Spiritual Well-Being Scale (SWBS)] were measured. ResultsParental war exposure and offspring psychopathology were statistically mediated by parental psychopathology, but not ACE exposure. Offspring of parents with (vs without) high levels of psychopathology had 3.72 times higher odds of reporting high levels of psychopathology themselves. Findings showed that the correlation between trauma exposure and psychopathology was moderated by perceived social support and spirituality. However, the correlation was only significant for higher levels of social support and spirituality. DiscussionThese results suggest that the presence of the proximal risk factor "low social support” may affect psychopathology negatively no matter the amount of adverse experiences consistent with a recency model of adversity. If social support is at least moderate, the distal risk factor “adverse experiences/ war trauma” impacts psychopathology. Overall, these findings highlight the need for trauma-informed mental health support for people fleeing from or residing in countries with ongoing or recent armed conflicts.

Lifetime history of childhood adversity and substance abuse in patients with treatment resistant depression

Both adverse childhood experiences (ACEs) and substance abuse have shown individual associations with treatment-resistant depression (TRD). Yet, limited research has explored the joint association of ACEs and substance abuse in TRD patients. This study aimed to evaluate how the amount and type of ACE exposure increase the risk of lifetime substance abuse in a clinical sample of 725 outpatients diagnosed with major depressive disorder (MDD) or persistent depressive disorder.Logistic regression analyses were used to assess whether heightened ACE exposure increased the risk of substance abuse, and to examine the relationship between five ACE subtypes (e.g., sexual abuse (CSA), physical violence, injury/illness, childhood grief, and parental upheaval) and history of substance abuse.Greater ACE exposure increased risk of substance abuse. CSA independently predicted a history of substance abuse. This provides further evidence for the additive effects of ACEs and that CSA may have a unique link to substance abuse.

The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation.

Adverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation. This study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs. Main effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups. Those with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.

Adverse childhood experiences among California student pharmacists.

Adverse childhood experiences (ACEs) are associated with higher mental and physical illness and substance use disorders in adulthood. However, little is known about the prevalence of ACEs among student pharmacists and the factors associated with exposure. Our objective was to determine the prevalence of ACEs, resilience, and maladaptive coping strategies among student pharmacists in California. Student pharmacists from 14 California pharmacy schools completed a 24-item online survey in 2020. This survey instrument comprised the ACEs questionnaire and collected data on the students' demographic characteristics, coping strategies, and resilience. Most respondents were Asian/Pacific Islander (n = 186, 61.0%), female (n = 216, 70.8%), and aged between 25 and 31 years (n = 154, 50.7%). Many (n = 137, 44.9%) students had more than 1 ACE exposure; 66 students (21.6%) had more than 3 ACEs. Many students indicated that they were diagnosed or suspected to be diagnosed with a mental health condition (n = 105, 34.4%) and agreed/strongly agreed that they struggled to manage the workload of pharmacy school (n = 119, 39.9%). Respondents with higher ACE scores (> 3) were more likely to report struggling with managing the workload of pharmacy school, have or suspect having a mental health condition, drink alcohol in the last 12 months, and/or have multiple sexual partners than students with lower ACE scores. More than 1 in 5 student pharmacists in this study were exposed to more than 3 ACEs. The student pharmacists' ACE exposure was associated with higher likelihood of mental health conditions and high-risk health behaviors. Further studies are needed to investigate this topic among student pharmacists.

Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples

Introduction: Adverse childhood experiences (ACEs) are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences (ACEs), individually and in combination, confer health risk distinct from a cumulative adversity score. This study evaluates whether individual and comorbid ACE exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression. Methods: Cross-sectional analysis of ACE assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416). We modeled cumulative ACE scores and the 5 most common distinct ACE components that comprise a given ACE score, up to a cumulative score of 4. We compared ACE components, adjusted for covariates. Results: Across both samples 23% and 57-58% of persons reported 1 ACE or 2 or more ACEs, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero ACEs and 14.2% for persons reporting one ACE. When the single ACE was experiencing parental divorce, smoking was higher (16.6%) compared to when the single ACE was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 ACE, respectively, whereas it was 26.6% if the single ACE was living with a mentally ill household member and 11.0% when the ACE was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative ACE scores. Conclusions: Cumulative ACE scores mask substantial health risk heterogeneity which can be delineated by examining distinct components of cumulative ACE scores.

Adverse childhood experiences, cognitive functioning, depression, and anxiety in adulthood.

Evidence suggests that adverse childhood experiences (ACEs) predict cognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding of how ACEs affect cognitive health in midadulthood. This study compared psychiatric and cognitive differences between adults at high- and low-risk of adverse health outcomes based on the ACE risk classification scheme. Adult patients (N = 211; 46.9% female; Mage = 44.1, SD = 17.1; Meducation = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. Patients were divided into high and low ACE groups based on the number of ACEs endorsed. Subsequently, a series of one-way analyses of variances were conducted to compare high versus low ACE groups on the Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-Fourth Edition Digit Span Test, Trail Making Test-Parts A and B, Rey Auditory Verbal Learning Test, Beck Depression Inventory-II, and Beck Anxiety Inventory scores. Significant group differences were detected for anxiety and depression with the high ACE group endorsing significantly greater depression and anxiety symptoms relative to the low ACE group. High and low ACE groups did not significantly differ on any cognitive measures. Results indicate that an individual's psychological health, but not cognitive functioning, is impacted by the level of ACE exposure. Study findings highlight the importance of including ACE measures in neuropsychological evaluations, as it will aid in case conceptualization and tailoring treatment recommendations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationships between childhood adversity and inflammatory biomarkers in adulthood: A cross-sectional analysis of a middle-to older-aged population

BackgroundExposure to adverse childhood experiences (ACEs) has been linked with increased cardiometabolic risk in adulthood. Low-grade systemic inflammation may underlie this association. Thus far, however, there has been limited investigation of later life inflammatory biomarkers in the context of childhood adversity. ObjectivesTo assess ACE history, and ACE subcategory, relationships with a broad range of inflammatory biomarkers in middle-to older-aged adults to test the hypothesis that ACE exposure is associated with an unfavourable inflammatory profile in adulthood and determine whether associations vary by ACE subtype and sex. MethodsThis study used data from a random sample of 1,839 men and women aged 46–74 years. Participant exposure to ACEs (overall and subtypes including abuse, neglect and household dysfunction) was determined using a validated 10-item ACE questionnaire. Inflammatory biomarkers (pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, white blood cell counts and their constituents, coagulation factors and glycoprotein acetyl) were measured from participant blood samples. Linear regression analyses examined relationships between ACE history (overall and each subcategory) and inflammatory biomarkers in adulthood, controlling for potential confounders. Sex-stratified and mediation analyses were also conducted. ResultsIn age and sex-adjusted models, ACE history was significantly associated with higher c-reactive protein (p = 0.027), resistin (p = 0.024), white blood cell count (WBC) (p = 0.034), monocyte (p = 0.044), eosinophil (p = 0.031) and plasminogen activator inhibitor-1 (p = 0.047) concentrations, and lower adiponectin (p = 0.025) levels. Results from stratified analyses indicated sex differences and ACE subtype specific associations, with household dysfunction identified as the main driver of positive ACE associations with WBCs and constituents (all p < 0.05). Mediation analyses suggested that BMI and smoking mediate relationships between ACE exposures and increased inflammation. ConclusionsThis study provides evidence that ACE exposure may be associated with more pro-inflammatory and pro-thrombotic profiles in adulthood. Associations differed according to ACE subtype, and sex differences exist, which may influence cardiometabolic risk.

Maternal parenting stress and social-emotional problems of Chinese preschoolers: The role of the mother-child relationship and maternal adverse childhood experiences

BackgroundPrevious research suggests that maternal parenting stress is a significant predictor of social-emotional problems in children. However, little is known regarding the mother-child relationship and the effect of maternal adverse childhood experiences (ACEs) on this association. MethodsThree waves of longitudinal panel data were collected from 2893 Chinese preschoolers with a follow-up interval of 6 months. The mothers of preschoolers were asked to complete anonymous questionnaires concerning demographic variables, maternal ACEs and parenting stress in Wave 1, mother-child relationships in Wave 2, and children's social-emotional problems in Wave 3. The parallel mediation model was conducted to analyze the mediating role of three dimensions of mother-child relationships, and the moderation model was conducted to examine the moderating role of maternal ACEs. ResultsThe results showed that maternal parenting stress predicted children's social-emotional problems directly or indirectly through the mother-child relationship, with an intimate mother-child relationship mediating this main effect negatively but a conflicted and dependent mother-child relationship mediating this main effect positively. In addition, moderating results indicated that the main effect of maternal parenting stress on children's social-emotional problems was more marked among participants with at least one maternal ACEs than those without maternal ACEs. Furthermore, the moderating effect was only detected in children whose mothers had a high school education or less. LimitationsThe subjectivity of mothers' reports may somewhat reduce the credibility due to the possible overestimation or underestimation of children's social-emotional problems. ConclusionThese findings provide new evidence for the effects of maternal parenting stress on children's social-emotional development and highlight the need for more attention to children with mothers having ACE exposure, lower educational level and poor parent-child relationships.

Adverse Childhood Experiences and Illegal Drug Use Among College Students: Findings from a French Sample.

While studies have demonstrated the negative impact of adverse childhood experiences (ACEs) on lifelong health, less is known about the relationship between ACEs and illegal drug use. Thus, the objective of the study was to examine the relationship between ACEs and illegal drug use among college students. French college students between 18 and 30 years enrolled in a university cohort study were eligible for inclusion. Multivariate logistic regression models were conducted for each drug. Among the sample (n = 1,157), 30.6% had no ACE exposure, 29.6%, 19.2%, and 20.7% had 1, 2 and ≥ 3 ACEs, respectively. Students with ACEs had a higher likelihood of using illegal drugs (p = 0.0067). After controlling for potential confounders, having ≥ 3 ACEs increased the risk of lifetime use of multiple drugs (aOR:10.9; 95% CI: 4.6-26.0), stimulants (aOR: 3.6; 95% CI:1.7-7.7), hallucinogens (aOR: 2.0; 95% CI: 1.1-3.5), cannabis (aOR: 4.7; 95% CI: 2.7-8.0), and risky illegal drugs (e.g., higher lifetime frequency drug use) (aOR: 2.9; 95% CI: 1.5-5.8). Estimates for illegal drug use were highest with parental substance use (aOR: 2.6; 95% CI; 1.5-4.4), sexual abuse (aOR: 2.3; 95% CI; 1.4-3.8), and divorce (aOR: 1.9; 95% CI: 1.3-2.7). ACEs increase the risk for lifetime illegal drug use and risky drug use in a dose-respondent fashion. These findings suggest that university students with higher levels of ACEs may benefit from additional support and services from clinical practitioners and university administrators.

Primary care nurse practitioners' perceptions and experiences communicating with adults about adverse childhood experiences.

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.

Adverse Childhood Experiences and Developmental Delay in Young US Children.

Adverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships. In this cross-sectional analysis of nationally-representative data from the 2017-2018 National Survey of Children's Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3-5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics. We found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17-3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25-4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33-1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57-2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs. Children with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.