Low Adverse Childhood Experiences Research Articles

Patterns of adverse childhood experiences and mental health symptoms among young adults

It is well known that adverse childhood experiences (ACEs) are linked with mental health problems. Identifying different patterns of exposure to adverse childhood experiences can provide information regarding what types of adversity may place individuals at most risk for poor mental health. The aims of our study were to identify underlying patterns of 10 types of ACEs in a sample of young adults (i.e., 18–21 years) and to examine relations between the ACEs classes and mental health symptoms (i.e., somatization, depression, anxiety, overall psychological stress). We found that a three-class model fit the data best: low ACEs, high emotional abuse only, and high multiple ACEs. We found significant differences across classes for all mental health symptoms. The high multiple ACEs class had significantly higher mean somatization, anxiety, and overall psychological stress scores than both the high emotional abuse only and low ACEs classes, and the high emotional abuse only class had higher mean anxiety and overall psychological stress scores in comparison to the low ACEs class. In contrast, our results suggest that the low ACEs and high emotional abuse only classes had higher mean levels of depression symptoms than the high multiple ACEs class. Our findings highlight the importance of examining the unique effects of different patterns of exposure to ACEs on mental health to inform prevention and intervention efforts that mitigate the harmful effects of ACEs on mental health.

Role of Maternal Adverse Childhood Experiences on Infant Neglect: A Multi-Perspective Approach.

We explored the intergenerational transmission effects of maternal adverse childhood experiences (ACEs) and infant neglect from multiple perspectives. The study included a sample of postpartum mothers and infants (N = 550) from the outpatient child health care department of a tertiary hospital in Jinan, Shandong Province, China. Our investigation followed three main lines of inquiry. First, the association of overall maternal ACEs with infant neglect was estimated. Secondly, the cumulative and independent effects of maternal ACEs on infant neglect were explored using the Adverse Childhood Experience Questionnaire-Revised (ACEQ-R) with 14 types of ACEs. Finally, the different patterns of 14 maternal ACEs were identified, and the association between the different patterns and infant neglect was explored. There were three main findings. First, infants born to mothers with ACEs experienced higher levels of neglect compared to those born to mothers without ACEs. Second, infants born to mothers with three or more subtypes of ACEs experienced the greatest levels of neglect, with maternal childhood physical neglect emerging as a particularly influential factor. Third, infants in the "median maternal ACEs" and "high maternal neglect and poor peer relationship" groups experienced more severe neglect than those in the "low maternal ACEs" group. These results suggest that early life experiences substantially shape future parenting behaviors, such as infant neglect.

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.

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.

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.

Patterns of adverse childhood experiences and associations with lower mental well-being among university students

BackgroundUniversity students report high levels of adverse childhood experiences (ACEs), which can lead to severe mental health problems. Understanding how ACEs impact well-being in this population is essential, yet research to date is limited. ObjectiveTo explore ACE patterns and their association with lower well-being in university students. Participants and setting1023 Spanish students (71.6 % female) aged between 18 and 64 years old (M = 20.10, SD = 3.93) completed a self-report questionnaire. MethodsThis study used a cross-sectional design. The ACE International Questionnaire (ACE-IQ) and the Short Warwick-Edinburgh Mental Well-being Scale were used to assess, respectively, childhood adversities and mental well-being. Latent Class Analysis and regression modeling were conducted to analyze the link between ACEs and lower mental well-being, considering the covariates of age, country of origin, sexual orientation, and mental illness. ResultsFour ACE classes were identified: Low ACEs (49.5 %), Dysfunctional Household (12.3 %), Household and Peer Abuse (31.0 %), and High ACEs (7.2 %). The regression analysis (F(3, 1007) = 19.2, p < .001, R2adj = 0.054) successfully predicted well-being scores based on ACE classes. When compared with the Low ACE class, all other classes exhibited lower levels of well-being. Age, sexual orientation, and mental illness were also related to lower well-being, with mental illness having the strongest negative effect (β = −0.635, t(1015) = −6.49, p < .001). ConclusionsThese findings underscore the relationship between childhood adversity and mental health, offering insights for future prevention efforts and enriching our understanding of ACEs and their impact on well-being.

College student mental health: Psychiatric risk and psychological wellbeing

Objective To examine both psychiatric risk and psychological wellbeing in a college student sample drawn from a majority-minority university. Participants 100 participants (42% White; 70 females), mean age, 21.22 years. Methods Univariate and multivariate analyses examined the relationship of psychiatric risk (Brief Symptom Inventory; BSI) and psychological wellbeing (Mental Health Continuum-Short Form; MHC-SF) with student stress, cognition, Adverse Childhood Experiences (ACEs) and a new Positive Childhood Experiences (PCEs) scale. Results Risk correlated with increased student stress, higher ACEs and lower PCEs, whereas wellbeing correlated with lower student stress, better neuropsychological functioning, lower ACE and increased PCEs. PCEs predicted enhanced MHC-SF wellbeing and reduced BSI risk, accounting for 22.4% and 13.7% of variance in these measures, respectively. ACEs predicted elevated BSI risk and diminished MHC-SF wellbeing accounting for 8.6% and 5.9% of variance in these measures, respectively. Conclusion College student mental health may benefit from practices aim specifically to enhance wellbeing, stress-resistance, and cognition.

The Association Between Adverse Childhood Experiences and Preterm Delivery: A Latent Class Approach.

Background: Racial and socioeconomic status (SES) disparities in preterm delivery (PTD) have existed in the United States for decades. Disproportionate maternal exposures to adverse childhood experiences (ACEs) may increase the risk for adverse birth outcomes. Moreover, racial and SES disparities exist in the prevalence of ACEs, underscoring the need for research that examines whether ACEs contribute to racial and SES disparities in PTD. Methods: We examined the relationship between ACEs and PTD in a longitudinal sample of N = 3,884 women from the National Longitudinal Study of Adolescent to Adult Health (1994-2018). We applied latent class analysis to (1) identify subgroups of women characterized by patterns of ACE occurrence; (2) estimate the association between latent class membership (LCM) and PTD, and (3) examine whether race and SES influence LCM or the association between LCM and PTD. Results: Two latent classes were identified, with women in the high ACEs class characterized by a higher probability of emotional abuse, physical abuse, sexual abuse, and foster care placement compared with the low ACEs class, but neither class was associated with PTD. Race and SES did not predict LCM. Conclusions: Our findings suggest that ACEs may not impact PTD risk in previously hypothesized ways. Future research should assess the impact of ACEs on the probability of having live birth pregnancies as well as the role of potential protective factors in mitigating the impact of ACEs on PTD.

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.

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.

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).

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis.

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

The impact of adverse childhood experiences and posttraumatic stress symptoms on chronic pain.

Chronic pain is a prevalent worldwide health condition. The current study aimed to extend previous research that investigated the dynamics between chronic pain, adverse childhood experiences (ACEs), and post-traumatic stress symptoms (PTSS). Adult participants worldwide with chronic pain were recruited for this study (N = 199; 89% females). Three hypotheses were proposed: (a) a high ACEs score would result in more severe pain intensity and interference compared to no ACEs; (b) a low ACEs score would result in more severe pain intensity and interference compared to no ACEs; and (c) PTSS would fully mediate the ACEs-pain relationship. Initially results indicated individuals with high ACEs reported more pain interference than those with no ACEs, although pain intensity did not differ between high and no ACEs. However, after controlling for age, socioeconomic status (SES), and pain duration, low and high ACEs were not significantly associated with pain intensity or interference compared to no ACEs. However, SES status was associated with pain intensity and interference, although not with pain interference after adding low and high ACEs to the model. Because of this the mediation exploration of PTSS was not viable. Implications for practice, limitations and future research outcomes are outlined.

47 Exposure to Early Life Adversity is Related to Alterations in Neural Correlates of Inhibitory Control in Preadolescents: Findings from the ABCD Study Cohort

Objective:Rapid neurodevelopment occurs during adolescence, which may increase the developing brain’s susceptibility to environmental risk and resilience factors. Adverse childhood experiences (ACEs) may confer additional risk to the developing brain, where ACEs have been linked with alterations in BOLD signaling in brain regions underlying inhibitory control. Potential resiliency factors, like a positive family environment, may attenuate the risk associated with ACEs, but limited research has examined potential buffers to adversity’s impact on the developing brain. The current study aimed to examine how ACEs relate to BOLD response during successful inhibition on the Stop Signal Task (SST) in regions underlying inhibitory control from late childhood to early adolescence and will assess whether aspects of the family environment moderate this relationship.Participants and Methods:Participants (N= 9,080; Mage= 10.7, range= 9-13.8 years old; 48.5% female, 70.1% non-Hispanic White) were drawn from the larger Adolescent Brain Cognitive Development (ABCD) Study cohort. ACE risk scores were created (by EAS) using parent and child reports of youth’s exposure to adverse experiences collected at baseline to 2-year follow-up. For family environment, levels of family conflict were assessed based on youth reports on the Family Environment Scale at baseline and 2-year follow-up. The SST, a task-based fMRI paradigm, was used to measure inhibitory control (contrast: correct stop &gt; correct go); the task was administered at baseline and 2-year follow-up. Participants were excluded if flagged for poor task performance. ROIs included left and right dorsolateral prefrontal cortex, anterior cingulate cortex, anterior insula, inferior frontal gyrus (IFG), and pre-supplementary motor area (pre-SMA). Separate linear mixed-effects models were conducted to assess the relationship between ACEs and BOLD signaling in ROIs while controlling for demographics (age, sex assigned at birth, race, ethnicity, household income, parental education), internalizing scores, and random effects of subject and MRI model.Results:Greater ACEs was associated with reduced BOLD response in the opercular region of the right IFG (b= -0.002, p= .02) and left (b= -0.002, p= .01) and right pre-SMA (b= -0.002, p= .01). Family conflict was related to altered activation patterns in the left pre-SMA, where youth with lower family conflict demonstrated a more robust negative relationship (b=.001, p= .04). ACEs were not a significant predictor in other ROIs, and the relationship between ACEs and BOLD response did not significantly differ across time. Follow-up brain-behavior correlations showed that in youth with lower ACEs, there was a negative correlation between increased activation in the pre-SMA and less impulsive behaviors.Conclusions:Preadolescents with ACE history show blunted activation in regions underlying inhibitory control, which may increase the risk for future poorer inhibitory control with downstream implications for behavioral/health outcomes. Further, results demonstrate preliminary evidence for the family environment’s contributions to brain health. Future work is needed to examine other resiliency factors that may modulate the impact of ACE exposure during childhood and adolescence. Further, clinical scientists should continue to examine the relationship between ACEs and neural and behavioral correlates of inhibitory control across adolescent development, as risk-taking behaviors progress.

12 The Effect of Adverse Childhood Experiences on Minnesota Multiphasic Personality Inventory-2-Restructured Form Symptom Reporting Among Adult Neuropsychological Referrals

Objective:Adverse childhood experiences (ACEs) is a broad construct that refers to negative events one may experience during childhood, including, but not limited to, childhood maltreatment, household dysfunction, and trauma. ACEs have consistently shown to be associated with negative physical and mental health outcomes. Although researchers have investigated the effects of trauma and abuse on personality measures, few studies have examined differences between those with high ACEs, low ACEs, and no ACEs on measures of personality in the context of neuropsychological evaluations.Participants and Methods:The current study included 128 consecutive adult patients referred for outpatient neuropsychological evaluation of attention-deficit/hyperactivity disorder. The sample was 39.8% non-Hispanic White, 21.9% non-Hispanic Black, 16.4% Hispanic, 10.9% Asian/Pacific Islander, and 10.9% other race/ethnicity, with a mean age of 27.9 years (SD=6.3) and mean education of 16.1 years (SD=2.2). Multivariate analyses of variance were performed to evaluate differences on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) between individuals who experienced high levels of ACEs (&gt;4/10 on the Adverse Childhood Experiences Questionnaire), low levels of ACEs (1-3/10), and no ACEs (0/10).Results:When analyzing Higher-Order (H-O) scales, there was a significant group difference in mean elevation on the Behavioral/Externalizing Dysfunction (BXD) scale, F(2,113)=3.124, p &lt; .05, such that individuals in the high ACEs group evidenced higher scores than those in the low ACEs group (p &lt; .05). Additionally, there were significant differences on several Restructured Clinical (RC) scales. Specifically, there were group differences on the Low Positive Emotions (RC2) scale, F(2,113)=3.427, p &lt; .05, such that those in the low ACEs group evidenced higher scores than those in the no ACEs group (p &lt; .05). The Antisocial Behavior (RC4) scale also had significant differences, F(2,113)=13.703, p &lt; .001, such that those in the high ACEs group had higher scores than those in the low and no ACEs groups (p &lt; .001). Finally, the Ideas of Persecution (RC6) scale yielded significant group differences, F(2,113)=4.793, p &lt; .05, such that those in the high ACEs group evidenced higher scores than those in the low and no ACEs groups (p &lt; .05).Conclusions:In sum, this study demonstrated that ACEs, particularly high levels of ACEs, are related to higher difficulties with problems with under-controlled and rule-breaking behaviors, low positive emotional responses, and beliefs that others pose a threat. As such, assessment of ACEs may serve an important role in characterizing patients’ psychological status as part of a comprehensive neuropsychological evaluation.

High caregiver adverse childhood experiences are associated with pediatric influenza and COVID-19 vaccination uptake.

Factors surrounding vaccine uptake are complex. Although anxiety, which could influence vaccination decisions, has been associated with adverse childhood experiences (ACEs), little is known about links between caregiver ACEs and pediatric vaccine uptake. We evaluated associations between caregivers' ACEs and decisions to vaccinate their children with influenza and COVID-19 vaccines. A cross-sectional study of caregivers of patients ≥6 months at one pediatric primary care center was performed. Caregivers completed a 19-question survey examining caregiver ACEs, influenza vaccine acceptance and beliefs, and intention to vaccinate their child with the COVID-19 vaccine. Demographic characteristics, social risks (e.g., housing and food insecurity), and vaccination data for children present with each caregiver were extracted from the electronic health record. Statistical analyses included chi-square tests for categorical and t-tests for continuous variables. A total of 240 caregivers participated, representing 283 children (mean age of 5.9 years, 47% male). Twenty-four percent (n=58) had high ACEs (≥4). Of those with high ACEs, 55% accepted pediatric influenza vaccination compared to 38% with low ACEs (p=0.02). Those with high ACEs had more positive attitudes toward influenza vaccine safety and efficacy (p≤0.02). Those with high, compared to low, ACEs were also more likely to accept COVID-19 vaccination (38% vs. 24%; p=0.04). Pediatric influenza vaccination rates and intention to vaccinate children against COVID-19 differed between caregivers with high and low ACEs: those with more ACEs were more likely to vaccinate. Further studies assessing the role of caregiver ACEs on vaccine decision-making are warranted.

Patterns of Familial and Racial Trauma and Their Associations with Substance Use Disorders among Racial/Ethnic Minority Adults.

Racial/ethnic minorities in the United States often experience many different types of traumatic events. We examine the patterns of familial and racial trauma and their associations with substance use disorders (SUDs) among racial/ethnic minority adults. We used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III. The study sample included 17,115 individuals who were Hispanic (43.6%), Black (34.9%), Asian American and Pacific Islander (17.0%), and American Indian or Alaska Native (AI/AN, 4.6%). Latent class analysis models with covariates and distal outcomes were analyzed to investigate patterns of trauma exposure and estimate binary outcomes of SUDs. Familial and racial trauma was measured by ten areas of adverse childhood experiences (ACEs) and six items of racial discrimination. We found four distinctive groups: low trauma (Class 1, 62.1%), high discrimination (Class 2, 17.2%), high ACEs (Class 2, 14.9%), and high trauma (Class 4, 5.9%). Compared to Class 1, other groups were more likely to include Black and AI/AN adults. Participants in Class 2 reported greater risks for alcohol and other drug use disorders. Those in Class 3 and 4 reported greater risks for alcohol, opioid, stimulant, and other drug use disorders. Given a higher risk of trauma exposure in Black and AI/AN adults, racially and ethnically sensitive trauma-focused interventions may help prevent and reduce SUDs in those populations.

Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa

BackgroundMultiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health. ObjectiveTo assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa. Participants and settingWe used pooled data of young men and women aged 19–24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (nf = 7183; nm = 2207). MethodsWe estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck–Croon–Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes. ResultsA six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males. ConclusionsDiscrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa.

Adverse Childhood Experiences Impact Burnout in Athletic Trainers: An Exploratory Study.

Burnout, a state of physical or emotional exhaustion, is a concern within athletic training, as between 17 and 40% of athletic trainers (ATs) report high levels of burnout. Adverse childhood experiences (ACEs) are linked with higher levels of burnout in other health professions. To compare burnout to ACEs in athletic trainers. Cross-sectional study. Web-based survey. 1000 ATs were selected at random to participate in the study. 78 ATs started the survey, with 75 ATs completing the survey. Burnout as measured by the Copenhagen Burnout Index (CBI) overall and subscale scores were compared across groups based on number of adverse experiences as measures by the ACES survey. Multiple ANOVAs were used to determine the association between ACE score and overall, personal, work, and patient-related burnout. Bonferroni post hoc corrections were used, and the a priori alpha level was p≤.05. The study protocol was approved by the IRB. At least one adverse experience was reported in 37 (49.33%) participants. Those with 4 or more ACEs had higher odds of reporting overall, personal and work-related burnout than those with 0-3 ACEs. Moderate burnout (CBI≥50.00) was reported in 27 (36%; overall), 44 (58.67%, personal), 34 (45.3% work-related), and 15 (20.00%, patient-related) ATs. Participants with 4 ACEs had significantly higher overall burnout (67.11±19.89; ANOVA F6, 68=2.59, p=.03) than those with 0 (40.53 ±17.12, p=.04), 1 (38.42±20.99, p=.04), and 7 (19.08±12.09, p=.03) ACEs. The same pattern existed with personal burnout as participants with 4 ACES (76.67 ±17.33) had significantly higher scores (ANOVA F6, 68=3.40 p=.00) than those with 0 (46.60 ±17.49, p=.02), 1 (42.78±21.48, p=.01), and 7 (27.08±20.62, p=.03) ACEs. No other significant differences existed. Between 20.00% and 58.67% of ATs surveyed reported some form of burnout. Higher levels of overall and personal burnout were found in those with 4 ACEs. While it was expected to see lower levels of burnout in those with lower ACEs, it was surprising to see that those with 7 reported some of the lowest CBI scores. It might be beneficial for ATs with childhood trauma to engage in self-regulation exercises to reduce limit triggers and burnout. Additionally, employers should explore becoming trauma-informed workplaces to better support employees.

Childhood adversity predicts Intimate Partner Violence among American Indian women

PurposeAmerican Indian (AI) populations experience high rates of Adverse Childhood Experiences (ACEs) compared to other racial/ethnic groups. Intimate Partner Violence (IPV) is a contributing factor in the Missing Murdered Indigenous People crisis. To provide data regarding ACEs and IPV surrounding pregnancy among AI populations, we tested the hypothesis that AI women with high ACEs would have higher risk of IPV and explored potential effect modification by income. MethodsData for 2341 (weighted) AI women were drawn from 2017 to 2020 North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) Survey. Participants reported yes/no to 10 ACEs questions regarding traumatic experiences before age 18 (high ACEs≥2). IPV was self-reported before or during pregnancy (perpetrator: husband/partner, ex-husband/ex-partner, or any). Annual income was dichotomized(high: >$16,000) on sample median. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (95% CI) for the association between ACEs and IPV before and during pregnancy, overall, and by income. Analyses were adjusted for sociodemographic factors. ResultsCompared to those with low ACEs, women with high ACEs were more likely to experience any IPV before (OR: 3.24, 95% CI: 1.78, 5.88) and during (OR: 2.34, 95% CI: 1.27, 4.31) pregnancy. Experience of sexual, verbal, physical violence, and exposure to intergenerational violence were associated with at least two-fold higher odds of any IPV before and during pregnancy. Effect modification by income was inconsistent. ConclusionsHigh ACEs were associated with IPV surrounding pregnancy among AI women. Sexual, verbal, physical, and intergenerational violence ACEs may particularly increase risk of IPV. Given the Missing Murdered Indigenous People crisis and perinatal disparities facing AI populations, these data are important to address ACEs and IPV among AI populations.