Adverse Childhood Experiences Scores Research Articles

A Qualitative Study of Pediatricians' Adverse Childhood Experiences Screening Workflows.

Adverse childhood experiences (ACEs) are associated with poor health outcomes over the life course. Interest in ACEs screening is growing, but standard ACEs screening workflows have yet to be established. We aimed to describe common workflow processes and variation among pediatricians who have successfully implemented ACEs screening and response protocols. We conducted semi-structured interviews with members of the American Academy of Pediatrics who practiced in clinical pediatric settings that implemented standardized ACEs screening (n=18 physicians). Interviews were coded and analyzed using thematic content analysis and clinical processes were examined for differences across ACEs screening workflow processes. ACEs screening workflows varied considerably, hinging primarily on determination of a positive screen, the type of interventions recommended in response, and protocolization of the workflow. We identified 5 major theme domains related to ACEs screening workflows: 1) degree of protocolization of the workflow, 2) screening tool(s) used, 3) timing of screening, 4) clinic staff involvement, and 5) interventions recommended and/or initiated by the physician. Common workflow processes were identified and grouped based on determination of and thresholds for response to a positive screen. Clinicians used symptoms, ACE score, or a combination of the 2 as criteria for deciding when to intervene and to what degree, though protocolization of this approach varied. ACEs screening workflow variability was largely driven by clinical feasibility and availability of ACEs intervention resources. This variability demonstrates that a one-size-fits-all standardized screening protocol may not be universally feasible or appropriate across practices.

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

ObjectivesTo report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate...

The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa.

Mental health problems among adults are a growing public health concern, and middle-income countries such as South Africa are disproportionally affected. Using a large scale nationally representative weighted survey, we assessed the prevalence of probable depression, probable anxiety, and adverse childhood experiences (ACEs), and explored associations between probable depression, probable anxiety, ACEs, socio-economic status, and demographic characteristics. Nationally, 25.7, 17.8, and 23.6% of respondents, respectively, reported scores of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), indicating probable depression or probable anxiety, and an ACE score of ≥4 (high exposure). Overall probable depression prevalence across South Africa varied from 14.7 to 38.8%. Both probable depression and probable anxiety were more frequently reported among adults who were: retired and older (>65 years of age), and widowed, divorced, or separated; living in metropolitan areas; and only had primary school education. In a multivariable adjusted logistic regression, the likelihood of reporting probable depression or probable anxiety was also found to increase with each standard deviation increase in the ACE score (p < 0.001), independent of other socio-demographic determinants. The prevalence of probable depression among respondents in South Africa varies significantly across the nine provinces. Furthermore, higher ACE score and several socio-demographic determinants were associated with a higher likelihood of probable depression and probable anxiety. Adult mental health services are urgently needed to identify groups of the population vulnerable to mental health problems for better targeting of interventions. Given the range of probable depression prevalence across the country, provincial level plans and resources should also reflect the burden of mental health problems in that province.

Evolving Our Understanding: Housing Instability as an ACE for Young Children.

We investigated the conceptualization and impact of adverse childhood experiences (ACEs) in a sample of 231 children ages 3–5 living in poverty and experiencing homelessness, focusing specifically on caregiver well-being and housing instability. Data was collected using the Neurodevelopmental Ecological Screening Tool (NEST), which screens for developmental risk and resilience across three domains (neurodevelopmental, caregiver, and environment). We used structural equation modelling (SEM) to test the association between domains and ACE scores and assessed the impact on neurodevelopmental constructs. Fifty-five percent of the sample had high ACE scores (> 3), which were associated with lower attention, social skills, and emotional regulation. ACEs were strongly associated with 0.17 standard deviation units of higher levels of caregiver distress (p < .001), which was also associated with 0.26 standard deviation units of lower levels of child neurodevelopmental functioning (p = .001). For each unit increase in housing instability, there was a three-fourths increase in ACE (0.78 ACE at p = .004); four or more moves were associated with the worst neurodevelopmental outcomes (53% of the sample). We must use an ecological, developmental lens to understand how early adversity impacts children, at what age, and in what context. Housing stability plays a critical role in developmental well-being and should be accounted for in conceptualizations of child ACE scales. Caregiver and child relationships are reciprocal, and so the impacts of ACEs are also bidirectional. Our policies and practices at individual, community, and systemic levels should account for these dynamics to improve child well-being.

Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine

Childhood adversity profoundly influences health, well-being, and longevity. Prevention and interventions to mitigate its harmful effects are essential. The American College of Preventive Medicine reviewed the research literature and other professional and governmental statements about adverse childhood experiences to support the development of evidence-based and population-focused recommendations about prevention, screening, and mitigation interventions for childhood adversity. We performed an umbrella review to find, assess and synthesize the evidence from systematic reviews focused on 3 key questions: the prevention or mitigation of the effects of adverse childhood experiences; the association of screening for adverse childhood experiences with various benefits, including health outcomes; and the effectiveness and harms of interventions in individuals with elevated adverse childhood experience scores. Adverse childhood experience‒related recommendations from 6 professional and governmental organizations were also reviewed. On the basis of these reviews, the American College of Preventive Medicine developed a position statement through consensus. A total of 8 systematic reviews, including 260 studies in total, were identified and combined with adverse childhood experiences‒related recommendations from 6 professional organizations to support the American College of Preventive Medicine recommendations. The American College of Preventive Medicine offers 7 adverse childhood experiences‒related recommendations focused on screening, education/training, policy/practice, and research: 2 are evidence-based, and 5 are based on expert opinion. Notably, regarding secondary prevention of adverse childhood experiences, the American College of Preventive Medicine endorses population-level surveillance and research around childhood adversity but not adverse childhood experience screening in individual clinical encounters. Despite limitations in the heterogeneity and quality of the published systematic reviews, the extant literature supports the American College of Preventive Medicine recommendations. Interventions to enhance protective factors and prevent and mitigate the consequences of adverse childhood experiences and other childhood adversity are promising and require further implementation and research.

Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes.

This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9kg vs 13.3kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665g vs 3014g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.

Adverse childhood experiences and repetitive transcranial magnetic stimulation outcomes for depression

BackgroundHistory of adverse childhood experiences (ACEs) is associated with poorer treatment outcomes in depression. How ACEs affect outcomes from repetitive transcranial magnetic stimulation (rTMS) is not well-defined. The primary aim was to investigate whether ACEs affect depression outcomes in patients receiving high frequency rTMS, either deep TMS (dTMS) or intermittent theta burst stimulation (iTBS), to the left dorsolateral prefrontal cortex. MethodsThe Hamilton Depression Rating Scale (HAMD-17) was collected at baseline and every 2 weeks for 4–6 weeks. Outcomes included improvement in HAMD-17 and remission. The ACE-10 questionnaire was used to quantify categories of ACEs. Data from 99 patients with MDD receiving an acute rTMS course were analyzed. ResultsPatients had a mean of 2.4 ACEs (SD 2.5). No significant differences in outcomes were found between dTMS or iTBS so these data were pooled. Using a continuous ACE variable showed no significant impact on outcomes. Using a categorical ACE variable (0, 1, 2, 3, 4 or more) did not reveal significant effects of ACEs on outcomes. Higher ACE was associated with steeper decrease in HAMD-17 only from baseline to week 2 but not at other times. LimitationsThis was an open-label study. The well-validated ACE questionnaire does not measure severity or frequency of adversities. ConclusionsPatients with depression receiving rTMS reported on average 2.4 ACEs. ACE scores may lead to a steeper early decline in HAMD-17 but did not otherwise impact depression outcomes. Presence of high levels of ACEs should not preclude consideration of rTMS for depression.

How Positive and Negative Childhood Experiences Interact With Resiliency Theory and the General Theory of Crime in Juvenile Probationers

Self-control and resiliency in juveniles are each thought to be relevant to the onset of delinquency and recidivism, and both are related to family environments and other childhood experiences. The general theory of crime is well established within the literature as an explanation for offending at all ages, and resiliency perspectives stress the importance of things like independence and morality to avoiding/desisting from deviance among juveniles. Here, Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs) are examined among 3604 juvenile probationers in the contexts of the general theory of crime and the compensatory, protective factor, and challenge models of resiliency theory. Results show that high ACE scores were associated with diminished self-control, and high PCE scores were correlated with better self-control. Policy implications are discussed.

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

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

26.3 Two Dual-Brain Psychology Clinical Trials (DBPCTs) Using Unilateral Transcranial Photobiomodulation for Opioid Addiction, Depression, and Anxiety

The main objective is to review the use of 4-minute, comfortable treatments with unilateral transcranial photobiomodulation (UtPBM) and use based on dual-brain psychology (DBP) for the treatment of MDD, anxiety disorders, and opioid use disorder in participants or patients with adverse childhood experience (ACE) scores of 3 and higher.

Cumulative Social Disadvantage Associated with Childhood Arthritis: A Cross-Sectional Analysis of the National Survey of Children's Health.

Health disparities in juvenile idiopathic arthritis (JIA) remain poorly understood. Social disadvantage may have a cumulative impact on health, with recent analyses using combined scoring systems to measure their impact on outcomes. Our aim was to investigate cumulative social disadvantage on childhood arthritis by using a cumulative score to analyze its association with arthritis among a nationally representative sample of children. A cross-sectional analysis of the National Survey of Children's Health (2016-2019) was performed. A cumulative social disadvantage score was generated (1 point each, with a maximum score of 4): low guardian education (high school or less), low household income level (0-199% of federal poverty level), underinsured status (public or uninsured), and high adverse childhood experience (ACE) score (≥4). Univariate and multivariable (adjusting for age, sex, and race and ethnicity) logistic regression models were used to measure the association between cumulative social risk and the odds of an arthritis diagnosis and moderate-to-severe parent-reported arthritis severity. Of 131,774 surveys completed, a total of 365 children reported current arthritis. Cumulative social disadvantage was associated with an arthritis diagnosis, with the highest odds among those with a score of 4 (adjusted odds ratio [ORadj ] 12.4 [95% confidence interval (95% CI) 2.9-53.3]). Cumulative social disadvantage also was associated with increased odds of moderate-to-severe arthritis severity (ORadj 12.4 [95% CI 1.8-82.6]). In this nationally representative sample, accumulated social disadvantage, measured via a cumulative social disadvantage score based on income level, guardian education, insurance status, and ACE exposure, was associated with an arthritis diagnosis and moderate-to-severe arthritis severity.

Adverse childhood events and health-related quality of life among women undergoing hysterectomy for uterine leiomyoma

Background and Aim Psychosocial stress may increase fibroid risk, but associations with symptom severity, which often influence clinical management decisions, have been underexamined. Our objective is to examine associations between adverse childhood experiences (ACE) and symptom severity and symptom impact on health-related quality of life (HRQL) among women undergoing hysterectomy for treatment of their leiomyomas (fibroids). Methods We recruited 103 premenopausal women into the Fibroids, Observational Research on Genes and the Environment (FORGE) study who were seeking evaluation of fibroids at the Medical Faculty Associates in Washington D.C. and intending to undergo hysterectomy at the George Washington University Hospital. For exposure classification, we assessed eight ACE categories related to child abuse and household challenges. For outcome classification, we used the Uterine Fibroid Symptom and Quality of Life (UFS-QOL). The five-level Likert scale responses were summed to create composite scores; a lower symptom severity score indicated fewer symptoms, while a higher HRQL score indicated better quality of life. We ran quasi-poisson regressions (log-link) to examine associations between ACE scores and UFS-QOL composite scores adjusting for age, race/ethnicity, and education (N=89). Results The majority of participants were Black (73%); about half had private insurance (55%) and a college degree (49%). Cumulative ACE and symptom severity scores were higher among Black compared to non-Black women (p &amp;#x2264; 0.03). History of substance abuse in the household was associated with greater symptom severity (relative risk (RR) = 1.31, 95% CI: 1.07, 1.61), and worse HRQL (RR = 0.74, 95% CI: 0.55, 1.00). History of sexual abuse was also associated with worse HRQL (RR = 0.67, 95% CI: 0.48, 0.92). Conclusions Our study adds to the growing evidence that early life exposures to chronic stress may influence gynecologic health, including symptom-related quality of life. Keywords. Women’s health, gynecological health, health disparities, social-structural stressors

Adverse childhood experiences intensify retinal microvascular and inflammatory responses to semi-controlled acute traffic related air pollution exposure

Background: Potential synergy between childhood exposure to psychosocial stressors and traffic-related air pollution exposure, two factors that commonly overlap in socially disadvantaged groups, could increase the risk of cardiovascular disease and lead to greater health disparity than what is currently attributed to these factors independently. Aim: To test whether adverse childhood experiences (ACEs) potentiate the response of retinal microvasculature caliber and circulatory pro-inflammatory cytokines following a two-hour semi-controlled exposure to traffic related air pollution. Method: In a crossover experiment, 57 participants were exposed to near-traffic ambient air and filtered ambient air, in separate occasions for two hours each time. Central retinal arteriolar/venular equivalent (CRAE/CRVE), blood pressure, pulse, and circulating interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) were measured pre-exposure and, again, 1 hour and 24 hours post-exposure. ACEs were documented using the ACE questionnaire. Based on ACE scores, participants were grouped into high (ACE &amp;#x2265; 4) and low (ACE &amp;#x2264; 1) ACE groups. Microvascular and inflammatory response to the exposure were analyzed across groups. Results: ACE scores significantly predicted CRAE, IL-6, IL-8, and pulse reactivity. Left eye CRAE narrowing was greater in the high- vs. low-ACE group at 1-hour and 24-hours post-exposure. 24-hours post-exposure, IL-8 and pulse were significantly higher in the high- vs. low-ACE group. IL-6 was significantly lower in the high- vs. low-ACE group at 1-hour post-exposure. Conclusion: Our results support the hypothesis that ACEs may induce susceptibility to air pollution across the lifespan. These findings may thus help explain how health disparities develop and persist across the lifespan in persons who are most vulnerable to experiencing ACEs and poor air quality, leading to continued social disadvantage.

Adverse Childhood Experiences among Reproductive Age Women: Findings from the 2019 Behavioral Risk Factor Surveillance System.

Adverse childhood experiences (ACEs) are associated with many negative health outcomes. Despite this well-documented association, most research on how health conditions affect women's preconception and perinatal health overlooks ACEs. This study analyzes self-reported ACE history and health outcomes among young adults (ages 18-39) using data from the 2019 Behavioral Risk Factor Surveillance System. Our aims were to 1) assess differences by gender in overall ACE scores and specific ACEs; 2) identify trends in women's ACE scores by birth cohort; and 3) estimate the association of ACE scores with health conditions that increase risk for adverse perinatal outcomes. Findings include that women had higher overall ACE scores than men and that women were more likely to report experiencing seven of the eight ACEs queried. More than 23% of women respondents reported an ACE score of 4+, with a 3-percentage point difference between the youngest and oldest women in our sample. Compared with those reporting zero ACEs, women with four or more ACEs were almost four times as likely to report a history of depression and more than twice as likely to report fair or poor health, even after accounting for sociodemographic characteristics. Women with four or more ACEs were 62% more likely to have obesity, 41% more likely to report a hypertension diagnosis, and 36% more likely to report a diabetes diagnosis than those with zero ACEs. ACEs are a root cause in the development of adverse health conditions in young women, and their prevention should be central to policies aimed at improving women and children's well-being.

Relationship between adverse childhood experiences and symptom severity in adult men with Tourette Syndrome

Childhood adversity is associated with the development or expression of many neuropsychiatric disorders, including those with strong genetic underpinnings. Despite reported associations between perceived stress and tic severity, the relationship between potentially traumatic events in childhood and Tourette Syndrome (TS), a highly heritable neuropsychiatric disorder, is unknown. This study aimed to assess whether exposure to eight categories of adverse childhood experiences (ACEs) is associated with TS severity and impairment, and whether TS genetic risk modifies this association. Online survey data were collected from 351 adult males with TS who previously participated in genetic studies. Participants completed the ACE questionnaire and a lifetime version of the Yale Global Tic Severity Scale (YGTSS). Demographic and relevant health data were assessed; polygenic risk scores (PRS) measuring aggregated TS genetic risk were derived using genome-wide association data. Univariable and multivariable linear regressions examined the relationships between childhood adversity and retrospectively recalled worst-ever tic severity and impairment, adjusting for covariates. Potential gene-by-environment (GxE) interactions between ACE and PRS were estimated. After covariate adjustment, there was a significant graded dose-response relationship between ACE Scores and increases in lifetime worst-ever tic severity and impairment. There was some evidence that TS genetic risk moderated the relationship between ACE Score and tic impairment, but not tic severity, particularly for individuals with higher TS polygenic risk. We provide evidence that childhood adversity is associated with higher lifetime TS severity and impairment, although future longitudinal studies with genetically-sensitive designs are needed to determine whether these relationships are causal and/or directional.

Intake assessments of salivary cortisol, survey responses, and adverse childhood experiences are associated with recovery success in an abstinence-based treatment program for substance use disorders.

Connecting patients to treatment for a substance use disorder (SUD) that satisfies their needs is often complicated by confounding factors. A reliable measurement of patients' underlying stress level may be helpful because it often reflects many of the same confounders as their SUD. Whereas cortisol levels reflect physiological responses to stress, patients' cortisol levels during recovery from an SUD may serve as biomarkers for stressors that result in poor treatment outcomes, including early discontinuation of treatment. However, further exploration of the relationship between patients' cortisol levels and their treatment outcomes is needed for this approach to be clinically useful. We enrolled participants from an abstinence-based, male-only, residential alcohol and drug recovery program to examine the relationship between salivary cortisol, stress exposure, ACEs, and treatment retention. Participants who remained in the program <90 days had significantly higher initial cortisol levels than those who remained ≥90 days (0.62 ± 0.074 μg/dl vs. 0.36 ± 0.037 μg/dl). Kaplan-Meier curves differed significantly when we grouped participants according to whether their cortisol level was below or above the overall average of 0.49 ± 0.044 μg/dl, with the median numbers of days before discontinuing being 110 and 60, respectively. A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in μg/dl), marital/relationship status, andadverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively). Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery.

Examining the Relationships Between Adverse Childhood Experiences, Student Generational Status, and Exam Performance in Emerging Adult Undergraduates

Objectives: We aimed to understand how adverse childhood experiences (ACEs) correlated with undergraduates’ examination performance, while looking at the contributions of attentional control and resilience. Methods: Students aged 18–25 years were recruited from first-year Psychology classes (Total N = 488). ACE scores, as well as the Attention Control Scale and the Brief Resilience Scale, were measured in conjunction with students’ first exam score of the semester. Results: Participants with no (0) and high (4+) ACE burden had higher resilience compared to those with moderate (1–3) ACE burden. Higher examination scores related to greater levels of attentional control, but no relationship was found with resilience or ACEs. Conclusions: Contrary to predictions, ACEs were related to resilience but in a non-linear fashion. Students with highest ACE burden require further study to understand factors contributing to their academic and personal resilience.

Adverse childhood experiences and premature mortality through mid-adulthood: A five-decade prospective study

Adverse childhood experiences (ACEs) can have lasting effects on adult health and survival. In this study, we aimed to examine how the cumulative number and clustering patterns of ACEs were related to premature mortality. Participants (N=46 129; 45% White, 48% Black; 49·5% females) were offspring (born in 1959-1966) of participants enrolled in the Collaborative Perinatal Project (CPP). We conducted latent class analysis to examine the clustering patterns of ACEs assessed between children's birth and age seven. We also calculated the cumulative ACE scores of 13 individual ACEs. Cox regression models were used to examine the associations of ACE clusters and scores with risk of premature mortality from adolescence to mid-adulthood. At the start of the follow-up for mortality in 1979, participants were 12-20 years old (Mean=15·99 years), and within the 38-year follow-up through 2016, 3 344 deaths were observed among the 46 129 CPP offspring. Five latent classes of ACEs were identified. Compared to children with Low Adversity (48% of the sample), children in Family Instability (9%, HR=1·28, 95%CI 1·07-1·53), Poverty & Crowded Housing (21%, HR=1·41, 95%CI 1·24-1·62), and Poverty & Parental Separation (19%, HR=1·50, 95%CI 1·33-1·68) classes had higher hazards of premature mortality. In addition, children with 2 (HR=1·27, 95%CI 1·14-1·41), 3 (HR=1·29, 95%CI 1·15-1·45), and 4+ (HR=1·45, 95%CI 1·30-1·61) ACEs had higher hazards of mortality than those with no ACE. The clusters of Poverty & Crowded Housing (HR=1·28, 95%CI 1·10-1·49) and Poverty & Parental Separation (HR=1·23, 95%CI 1·02-1·48) remained associated with higher risk of premature mortality, beyond the cumulative risk of higher number of ACEs (HR=1·05, 95%CI 1·01-1·08). About half of the CPP cohort experienced early life adversities that clustered into four distinct patterns, which were associated with different risk of premature mortality. It is important to deepen our understanding of how specific clusters of childhood adversities affect health and premature mortality to better inform approaches to prevention and interventions.

Using network analysis to illuminate the intergenerational transmission of adversity

ABSTRACT Objective: The effects of maternal exposure to adverse childhood experiences (ACEs) may be transmitted to subsequent generations through various biopsychosocial mechanisms. However, studies tend to focus on exploring one or two focal pathways with less attention paid to links between different pathways. Using a network approach, this paper explores a range of core prenatal risk factors that may link maternal ACEs to infant preterm birth (PTB) and low birthweight (LBW). Methods: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 8379) to estimate two mixed graphical network models: Model 1 was constructed using adverse infant outcomes, biopsychosocial and environmental risk factors, forms of ACEs, and sociodemographic factors. In Model 2, ACEs were combined to represent a threshold ACEs score (≥4). Network indices (i.e., shortest path and bridge expected influence [1-step & 2-step]) were estimated to determine the shortest pathway from ACEs to infant outcomes, and to identify the risk factors that are vital in activating other risk factors and adverse outcomes. Results: Network analyses estimated a mutually reinforcing web of childhood and prenatal risk factors, with each risk connected to at least two other risks. Bridge influence indices suggested that childhood physical and sexual abuse and multiple ACEs were highly interconnected to others risks. Overall, risky health behaviours during pregnancy (i.e., smoking & illicit drug use) were identified as ‘active’ risk factors capable of affecting (directly and indirectly) other risk factors and contributing to the persistent activation of the global risk network. These risks may be considered priority candidate targets for interventions to disrupt intergenerational risk transmission. Our study demonstrates the promise of network analysis as an approach for illuminating the intergenerational transmission of adversity in its full complexity. HIGHLIGHTS We took a network approach to assessing links between ACEs and birth outcomes. ACEs, other prenatal risk factors, and birth outcomes had complex inter-connections Health behaviours in pregnancy were indicated as optimal intervention targets.

Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings.

Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.