Measures Of Adverse Childhood Experiences Research Articles

Exploring the Link Between Adverse Childhood Experiences and Adolescent Dating Violence Perpetration and Victimization: A Review of the Literature

Background and Purpose: Adverse childhood experiences (ACEs) have been linked with multiple adverse outcomes, including adolescent dating violence (ADV). ADV is a serious public health issue, with the U.S. rates ranging from 6.4% to 73% for victimization across all types and from 11% to 77% for perpetration. Given the high prevalence of ADV and the fact that it has been frequently linked with ACEs earlier in life, it is crucial to thoroughly understand this relation and apply this information to prevention and intervention efforts. However, to date, there are no known reviews synthesizing the link between ACEs and ADV, nor exploring which ACEs have been included across other studies. Methods: To address these gaps, this study included three comprehensive searches to identify the following: (1) the measurement tools used to measure ACEs; (2) the type of ACEs significantly linked with ADV; and (3) the risk and protective factors considered in this relation. Results: A total of 34 studies were included. There were 24 different assessment tools used to measure the ACEs of adolescents, with the number of ACEs included ranging from 1 to 93. All but one study linked at least one ACE to ADV. The types of ACEs linked with ADV consisted of victimization (e.g., child abuse and bullying), witnessing violence (i.e., home and school), and household dysfunction (e.g., caregiver substance abuse). Several risk and protective factors were considered. Conclusions/Implications: This study found the measurement of ACEs in the literature to be inconsistent, making it difficult to synthesize and compare the findings across studies. Despite the measurement inconsistencies, however, most studies linked ACEs with ADV, emphasizing the importance of considering this relation in prevention/intervention programming.

Cognitive and affective links between childhood adversity and psychological adjustment in emerging adults with chronic medical conditions.

Childhood adversity has been linked to poor psychological adjustment and decreased emotion regulation (ER) abilities. The extended process model of ER outlines the pivotal role of cognitive appraisals in the generation and expression of emotion as well as the pursuit of ER. The aim of the current study is to examine whether illness-related cognitive appraisals (i.e., illness uncertainty and illness intrusiveness) and emotion dysregulation serially mediate the relationship between childhood adversity and psychological adjustment for emerging adults with chronic medical conditions (CMCs). Participants included 557 undergraduate college students (Mage= 19.53 years, SD = 1.34) enrolled in a Midwestern public university with self-reported CMCs. Participants completed measures of adverse childhood experiences (ACEs), illness uncertainty, illness intrusiveness, emotion dysregulation, anxious symptoms, and depressive symptoms. A path analysis was conducted examining ACEs → cognitive appraisals (i.e., illness uncertainty, illness intrusiveness) → emotion dysregulation → depressive and anxious symptoms. The overall model was significant and predicted 63.5% of the variability in anxious symptoms and 60.2% of the variability in depressive symptoms. All anticipated direct and indirect paths were significant. The current study indicates that greater childhood adversity is indeed associated with negative appraisals of one's CMC, such as greater perceived uncertainty and intrusiveness. Negative illness-related cognitive appraisals thus may limit one's ability to effectively employ adaptive strategies to regulate emotions, which could contribute to greater depressive and anxious symptoms.

Emotional difficulties mediate the impact of adverse childhood experiences on compulsive buying-shopping problems.

Compulsive buying-shopping is recognised as a significant mental health concern, yet its aetiology is largely understudied. A known risk factor for compulsive buying-shopping is adverse childhood experiences (ACEs). ACEs are also associated with greater problems regulating emotions, as well as depression and anxiety. These factors are also known to be associated with compulsive buying-shopping problems. In this study, we aimed to test a serial mediation model in which ACEs were associated with compulsive buying-shopping problems via emotion dysregulation, and then emotional psychopathology (depression, anxiety). We tested this model cross-sectionally in two large samples (N = 1,868 & 4,742) to evaluate the robustness of the model. Both samples completed self-report measures of ACEs, emotional dysregulation, compulsive buying, depression, and anxiety symptoms. We found support for indirect effects, and all results were consistent for both samples. ACEs predicted greater emotion dysregulation, which then predicted greater depression and anxiety. In turn, anxiety (but not depression) predicted compulsive buying symptoms. Emotion dysregulation and anxiety consistently mediated the relationship between ACEs and compulsive buying symptoms. Both emotion dysregulation and anxiety represent malleable targets in clinical interventions for compulsive buying-shopping problems. Our findings also suggest that anxiety may be a stronger predictor of compulsive buying compared to depression, which may be an important avenue for future researchers to investigate.

Associations between Adverse Childhood Experiences (ACEs) and Complex-PTSD, moral injury and perceived social support: A latent class analysis

BackgroundAdverse Childhood Experiences (ACEs), including childhood abuse and neglect, are consistently linked to poorer mental health and psychosocial outcomes in adulthood. Complex-posttraumatic stress disorder (C-PTSD) and moral injury are two conditions which can cause significant distress and functional impairment in individuals affected by trauma. However, not much is known about the complex relationships between ACEs, C-PTSD and moral injury. Furthermore, while perceived social support is a commonly cited protective factor for C-PTSD, there is little understanding about how it relates to ACEs in traumatised populations. The aim of this study was to investigate ACEs in a trauma-affected sample of UK military veterans using latent class analysis. Secondly, the study tested for associations between latent classes of ACEs, severity of C-PTSD and moral injury, and levels of perceived social support. MethodData was collected from a UK military veterans mental health charity, from a clinical sample (N = 336) who were receiving treatment for mental health difficulties. Participants completed standardised measures of ACEs, C-PTSD, moral injury, and perceived social support. Data was analysed using a bias-adjusted 3-step approach latent class analysis. Wald statistics were used to test for associations between classes of ACEs and C-PTSD, moral injury and perceived social support. FindingsA two-class model was found to be the best fit for the data, which depicted two classes of ACEs within the sample. The classes showed a distinction between a group of participants who were more likely to endorse experiencing high levels of ACEs, and a separate group who endorsed relatively lower levels of ACEs. As such, the model was interpreted as depicting a low-ACEs (class 1) vs. high-ACEs (class 2) distinction. 56 % of participants fell into class 1 (low ACEs) with 44 % in class 2 (high ACEs). Participants in class 2 (high ACEs) were significantly more likely to score highly for symptoms of C-PTSD and moral injury, and to report lower levels of perceived social support. ConclusionThe present study is the first to report a two-class model of low vs high-ACEs in a clinical sample of UK military veterans. It also describes how membership of the high-ACEs class was significantly associated with higher scores for key mental health and psychosocial variables in C-PTSD, moral injury and perceived social support. The findings have important clinical implications in highlighting the possible role of ACEs in understanding the aetiology of psychopathology in military populations affected by trauma. It also adds to the growing literature which demonstrates how many military personnel experience significant levels of pre-existing trauma and adversity before entering service, and how this can contribute to the development of complex mental health outcomes in adulthood.

Maternal Adverse Childhood Experiences and Biological Aging During Pregnancy and in Newborns

Adverse childhood experiences (ACEs), potentially traumatic experiences occurring before the age of 18 years, are associated with epigenetic aging later in life and may be transmitted across generations. To test evidence of the transmission of biological embedding of life experience across generations by analyzing maternal ACEs and epigenetic clocks measured in mothers during pregnancy and in their children at birth. For this cross-sectional study, data from the Accessible Resource for Integrated Epigenomic Studies (ARIES) substudy of the Avon Longitudinal Study of Parents and Children (ALSPAC) were analyzed. The ALSPAC study recruited 14 541 women who gave birth in the Avon Health District in the UK between April 1, 1991, and December 31, 1992. The ARIES substudy comprised 1018 mother-offspring dyads based on the availability of DNA samples profiled in 2014. Epigenetic age was estimated using DNA methylation-based epigenetic clocks (including Horvath, Hannum, GrimAge, PhenoAge, and DunedinPACE) in mothers during pregnancy and the Knight and Bohlin cord blood epigenetic clocks in newborns. Analyses were performed between October 1, 2022, and November 30, 2023. A composite measure of maternal ACEs was the primary exposure in both maternal and offspring models; as a secondary analysis, individual ACEs were measured separately. The Edinburgh Postnatal Depression Scale (EPDS) was used to investigate depression during pregnancy as an exposure. Changes in epigenetic age acceleration (EAA) were investigated as the primary outcome in maternal models during pregnancy. Changes in epigenetic gestational age acceleration (GAA) were the primary outcome in offspring analyses. Linear regression analyses were used to determine the association between maternal ACEs and both outcomes. This study included 883 mother-child dyads. The mean (SD) maternal age at delivery was 29.8 (4.3) years. Pregnant women with higher ACE scores exhibited higher GrimAge EAA (β, 0.22 [95% CI, 0.12 to 0.33] years; P < .001). Maternal ACEs were not associated with GAA in newborns using P < .05 as a cutoff to determine statistical significance. Depression was associated with higher GrimAge EAA (β, 0.06 [95% CI, 0.02 to 0.10] years; P = .01) in mothers during pregnancy, but not in newborns, and did not mediate the association between ACEs and EAA. The findings of this study suggest that maternal ACEs may be associated with epigenetic aging later in life, including during pregnancy, supporting a role for maternal ACEs in offspring development and health later in life.

Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth.

Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.

Prevalence and validity of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD: A population-based survey of Hong Kong adults

The present study aimed to report the prevalence of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in the general adult Hong Kong population, and examine the validity of the Chinese International Trauma Questionnaire (ITQ). This descriptive cross-sectional population-based telephone survey included a representative sample of 1070 non-institutionalized permanent Hong Kong residents ages 18–64 years. Participants provided responses to the Chinese version of the ITQ, and measures of adverse childhood experiences (ACEs), depression, anxiety, and stress. Based on the diagnostic algorithm of the ITQ, 5.9% of the sample screened positive for either CPTSD or PTSD, with CPTSD (4.2%) being more common that PTSD (1.7%). Results of the confirmatory factor analysis indicated the first-order correlated 6-factor model to be the best fitting solution. Symptom cluster summed scores were all positively and significantly correlated with all criterion variables. This investigation established the prevalence rates of ICD-11 PTSD and CPTSD using a general adult population sample in Hong Kong. The Chinese ITQ demonstrated sound factorial validity and concurrent validity. Future research can further characterize ICD-11 PTSD and CPTSD in subgroups using the Chinese ITQ.

Recent Stressful Life Events and Perceived Stress as Serial Mediators of the Association between Adverse Childhood Events and Insomnia

Insomnia is common in college students and linked to poorer mental and physical health. There is growing evidence that adverse childhood experiences (ACEs) may contribute to insomnia in adulthood. However, beyond the need for additional replication of these findings, there is a need to identify underlying mechanisms that plausibly connect the two experiences. Based on a serial mediation model, the current study examined the role of two theoretically informed mediators: recent stressful life events and perceived stress. A cross-sectional survey of 2,218 college students at a large university in the southwestern United States was conducted between August 2020 and December 2021. The sample was predominantly Hispanic (96%) and female (73%), with a mean age of 20.7 years. Standardized measures of adverse childhood experiences, recent stressful life events, perceived stress, and insomnia were administered to participants online. Almost 20% of participants reported having experienced four or more adverse childhood experiences and 63% met the threshold for insomnia. Reporting four or more ACEs was associated with significantly greater insomnia severity, and this relationship was serially mediated by both recent stressful life events and perceived stress. However, recent stressful life events appeared to be the most powerful mediator. The results of the current study indicate that recent exposure to stressful life events serves as a plausible mechanism linking early adversity during childhood to adult insomnia and could therefore serve as a potential target for intervention. The findings suggest that students would benefit from university-wide efforts to reduce the number and/or intensity of common stressors.

A Short Adverse Experiences Measure Among Mothers of Young Children.

Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department. From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression. Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes. A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.

Measurement Invariance of Adverse Childhood Experiences Across Teacher Age and Race

ABSTRACT Adverse Childhood Experiences (ACEs) confer considerable risk for negative outcomes across the lifespan, but there is limited research examining whether the measurement of ACEs can be interpreted the same way across diverse groups of individuals. In particular, the measurement of ACEs among early child education teachers has received little attention. Given that millions of children receive care from early child education teachers, and evidence that ACEs can severely disrupt teacher’s abilities to support young children, it is critical to accurately assess for and respond to teacher ACEs. The present study examined the factor structure and measurement invariance of the 11-item Behavioral Risk Factor Surveillance Survey (BRFSS) version of the ACEs measure across a diverse group of teachers. Data were collected from 605 teachers in a southeastern state between 2018 and 2021. Teachers ranged in age from 18 to 81 years (35% young; 56% middle; and 9% older adults) and were diverse across race (46% White; 53% Black). Teachers completed the BRFSS version of the ACEs measure and a demographics questionnaire. Factor analyses replicated the theorized three-factor solution, with household dysfunction, emotional/psychological abuse, and sexual abuse emerging as distinct factors. Multigroup confirmatory factor analyses demonstrated measurement invariance across teacher age and race. Comparisons of scores indicated ACEs levels varied across teacher age and race. Overall, findings suggest the BRFSS version of the ACEs measure can be used to assess adverse childhood experiences across diverse groups of early child education teachers.

Adverse Childhood Experience-Related Conditions and Substance Use in Adolescents: A Secondary Analysis of Cross-Sectional Survey Data.

Adverse childhood experiences (ACEs) cluster within children. In addition to standardized ACE measures, there exist "ACE-related" measures that are either directly or indirectly related to the standardized ACE constructs. This study aimed to identify ACE-related latent classes of adolescents and describe past-month substance use in each class by sex and race/ethnicity. Data from the 2018 Indiana Youth Survey (N = 70,703), which is a repeated self-administered, cross-sectional survey, were used. Latent class analysis was conducted using ACE-related family (parent incarceration, insulting/yelling within family, inability to discuss personal problems) and school (hate being in school, feeling unsafe, inability to talk to teachers one-on-one) items. Dependent variable combined past 30-day use-frequency of 17 substances. Two-way analysis of variances examined ACE by sex and race/ethnicity interaction. Four ACE-related classes emerged: "Family-Only" (11.2%), "School-Only" (16.5%), "Family-School" (8.0%), and "No-ACE" (64.3%). Substance use was highest in "Family-School" (mean = 0.67); lowest in "No-ACE" (mean = 0.21). Significant race/ethnicity (F = 27.06; p < .0001), ACE * sex interaction (F = 12.13; p < .0001) and ACE * race/ethnicity interaction (F = 4.57; p < .0001) effects emerged. Within each ACE-related class, substance use was lowest for Asians and highest for Hispanics. Adverse childhood experience-related items cluster within children across school and family environments and clustering differs by race/ethnicity, but not by sex. Incorporating ACE-related items into school surveys enhances the ability to implement interventions that target relationships between ACEs and substance use.

Predicting comorbid mental health difficulties in people with autoimmune arthritis.

Little is known about variables impacting the association between mental health difficulties and autoimmune conditions. This study investigates whether, age of onset, adverse childhood experiences (ACEs), and 'illness invisibility' predict comorbid mental health difficulties in people with autoimmune arthritis. Participants with autoimmune arthritis (N = 209) were recruited via social media platforms. Age of onset of arthritis and the temporal order of mental health difficulties (if applicable) were collected alongside a measure of personality and ACEs. A novel measure of illness invisibility was developed for this study. A cross-sectional mixed-subject design was utilised. 53.5% of the sample endorsed lifetime mental health difficulties. Logistic regression analyses revealed participants with a younger age of onset of arthritis had significantly higher odds of developing a mental health problem (OR 0.93, 95% CI 0.90-0.96). Independently, Illness Invisibility, endorsed by 89.9% of participants, significantly predicted postmorbid mental health difficulties (OR 1.08, 95% CI 1.01-1.19). Adverse Childhood Experiences were frequently endorsed within the sample with 37.8% reporting ≥ 3 cumulative ACEs. Every unit increase in ACEs increased the odds of having comorbid mental health difficulties (OR 1.27, 95% CI 1.09-1.47). Young people who are diagnosed with autoimmune arthritis maybe more likely to experience subsequent mental health difficulties. The 'invisibility' of their illness and exposure to ACEs also is associated with their risk for mental health complications. These findings highlight the importance of mental health screening for young people being investigated for arthritis and interdisciplinary care, especially for young people.

Can adverse childhood experiences predict chronic health conditions? Development of trauma-informed, explainable machine learning models.

Decades of research have established the association between adverse childhood experiences (ACEs) and adult onset of chronic diseases, influenced by health behaviors and social determinants of health (SDoH). Machine Learning (ML) is a powerful tool for computing these complex associations and accurately predicting chronic health conditions. Using the 2021 Behavioral Risk Factor Surveillance Survey, we developed several ML models-random forest, logistic regression, support vector machine, Naïve Bayes, and K-Nearest Neighbor-over data from a sample of 52,268 respondents. We predicted 13 chronic health conditions based on ACE history, health behaviors, SDoH, and demographics. We further assessed each variable's importance in outcome prediction for model interpretability. We evaluated model performance via the Area Under the Curve (AUC) score. With the inclusion of data on ACEs, our models outperformed or demonstrated similar accuracies to existing models in the literature that used SDoH to predict health outcomes. The most accurate models predicted diabetes, pulmonary diseases, and heart attacks. The random forest model was the most effective for diabetes (AUC = 0.784) and heart attacks (AUC = 0.732), and the logistic regression model most accurately predicted pulmonary diseases (AUC = 0.753). The strongest predictors across models were age, ever monitored blood sugar or blood pressure, count of the monitoring behaviors for blood sugar or blood pressure, BMI, time of last cholesterol check, employment status, income, count of vaccines received, health insurance status, and total ACEs. A cumulative measure of ACEs was a stronger predictor than individual ACEs. Our models can provide an interpretable, trauma-informed framework to identify and intervene with at-risk individuals early to prevent chronic health conditions and address their inequalities in the U.S.

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).

A preliminary examination of the effects of childhood abuse and resilience on pain and physical functioning in patients with knee osteoarthritis.

We examined associations of a self-reported history of childhood abuse with pain and physical functioning in patients with knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA). We also explored the potential moderating effects of positive childhood experiences (PCEs), an index of resilience, on these associations. Prior to TKA, participants with KOA awaiting surgery (N = 239) completed self-report measures of adverse childhood experiences (ACEs), PCEs, pain, and physical functioning. We evaluated associations of pain and physical functioning (Brief Pain Inventory [BPI] and Western Ontario and McMaster University of Osteoarthritis Index [WOMAC]) based on the experience of ACEs (childhood abuse), with PCEs (childhood happiness and supportive parental care) as potential moderators. Greater exposure to childhood abuse was positively correlated with BPI pain interference as well as WOMAC pain and functioning scores. Additionally, childhood happiness and supportive parental care moderated the positive associations of childhood abuse with pain and physical functioning; though, surprisingly, the adverse effects of childhood abuse on these outcomes were more pronounced among participants with high levels of childhood happiness and supportive parental care. Overall, results show an association between a self-reported history of childhood abuse and pain and functioning in patients with KOA awaiting TKA. However, PCEs did not protect against the negative consequences of childhood abuse in our cohort. Further research is needed to validate these associations and gain a more comprehensive understanding of the complex interplay between childhood abuse and PCEs and their potential influences on pain experiences in adults with chronic pain conditions, including KOA.

Adverse Childhood Experiences and Problematic Cannabis Use: The Role of Emotion Dysregulation and Affective Impulsivity.

Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use in this population. The present study investigated whether emotion dysregulation mediates the relationship between adverse childhood experiences (ACEs) and problematic cannabis use, and whether affective impulsivity (negative and positive urgency) uniquely moderates this relationship. Participants consisted of current cannabis users (N = 586) recruited from five universities across Canada. Participants completed an online survey containing self-report measures of ACEs, emotion dysregulation, negative and positive urgency, and problematic cannabis use. Among the sample of postsecondary students, 36% (n = 213) met the threshold for problematic cannabis use. Moderated-mediation analyses revealed that ACEs were positively associated with emotion dysregulation and problematic cannabis use. There was also a significant indirect effect of emotion dysregulation on the association between ACEs and problematic cannabis use at moderate and high (but not low) levels of negative urgency, and at moderate and high (but not low) levels of positive urgency. The moderated-mediation models remained significant when controlling for other facets of impulsivity. Results suggest that elevated levels of emotion dysregulation and urgency are important proximal risk factors for problematic cannabis use among postsecondary students with a history of ACEs. While ACEs cannot be modified given their occurrence in the past, interventions that aim to build mindfulness and adaptive emotion regulation skills may be beneficial for reducing the likelihood that these students will engage in impulsive behaviors, such as cannabis use, when experiencing emotional distress.

Conceptualizing adverse childhood experiences as a latent factor: Tests of measurement invariance across five racial and ethnic groups.

Adverse childhood experiences (ACEs) are conventionally measured using a cumulative-risk index without consideration of distinct measurement properties across racial and ethnic groups. Drawing from the 2018-2020 National Survey of Children's Health (N = 93,759; 48% female; average age: 9.52 years), we assess the measurement invariance of a latent-factor ACE model across five groups: Hispanic children (14%) and non-Hispanic White (73%), Black (7%), Asian/Pacific Islander (5%), and American Indian/Alaskan Native (1%) children. Results support configural and full metric invariance across groups. However, several ACE item thresholds differed across groups. Findings highlight the potential utility of a latent factor approach and underscore the need to assess differences across racial and ethnic groups in terms of the optimal conceptualization and measurement of ACEs.

Towards an Implicit Measure of Patient Engagement in Sickle Cell Disease: Relationships between Implicit Measures of Engagement and Previous Childhood Trauma Among Adolescents and Young Adults

Background: Historically, patient engagement among adolescents and young adults (AYAs, age 18-25) decreases, parallel with the shift from parental to patient responsibility for engagement, and the transition from pediatric to adult care. Simultaneously, among AYAs with sickle cell disease (SCD), increases in organ failure, visits for VOCs, and mortality occur during this period. One previously shown predictor of excess hospital and ED utilization is prior childhood trauma, including medical trauma from treatment, parental abuse, or neglect. We found no implicit and few explicit measures of SCD AYA engagement in self-care or cooperation with professional care. We did find that Adverse Childhood Experiences (ACEs) are linked to increased morbidity. Particularly Emergency Department (ED) visits for pain, among children and adolescents with SCD. So, as part of validating an empirically derived implicit measure of SCD AYA engagement, we tested the relationship of the new measure to a validated measure of previous childhood trauma. Method: We studied selected AYA patients (N=20) enrolled in an Adult Sickle Cell Medical Home. Childhood trauma was assessed using the Center for Disease Control's 13-item, Behavioral Risk Factor Surveillance System Adverse Childhood Experience (ACE) module, measuring self-reported exposure to 9 types of childhood adversities: emotional abuse, physical abuse, sexual abuse, household member mental illness, household member substance abuse, witnessing domestic violence, parental separation or divorce, and incarcerated family members. The implicit measure of patient engagement was the draft 4-item Tiers of Engagement (TOE) tool. The original TOE was developed for pediatric patients and assessed parental as well as patient engagement. The adult TOE assesses only AYA engagement. The TOE tool asks professionals of all disciplines caring for SCD patients to confer as a group during interprofessional meetings to subjectively assign ratings of one (ideal engagement) to three (poor engagement) to four different domains: medical, educational, mental, and social. The analysis of variance (ANOVA) test was used to analyze the relationship between the ACE score and each of the engagement sectors (medical, educational, mental, and social). Results: The graphs below show ANOVA results for the relationship of the ACE score to each TOE domain score. We found no significant relationships between ACE scores and TOE domain scores. Conclusion: We observed no significant relationships between childhood trauma and implicitly measured patient engagement among AYAs with SCD. Future research should measure the TOE in larger samples and identify whether the TOE score is related to explicit measures of SCD AYA engagement, or hypothesized predictors of SCD AYA engagement and healthcare utilization. Future research should also utilize the ACE measures to implement trauma-informed care in AYAs with SCD.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not. The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

Does Social Support Moderate the Association between Adverse Childhood Experiences and Substance-Related Problems?

ABSTRACT Background: More than half of individuals in the United States have had adverse childhood experiences (ACEs), which can result in physical and mental distress. ACEs has been linked with greater likelihood of harmful alcohol and drug use. Research has found that protective factors, such as social support, may potentially buffer against harmful substance use engagement among those who have experienced ACEs. The purpose of this study was to examine associations between perceived social support, ACEs, and alcohol and cannabis-related problems. Moreover, this study aimed to examine if specific domains of perceived social support (family, friends, and significant other) moderated the relationship between ACEs and alcohol and cannabis-related problems. Method: Validated measures of ACEs, perceived social support, and alcohol and cannabis problems were collected in a sample of 401 emerging adults via Prolific Academic (an online data collection platform). Results: Overall perceived social support and domains such as perceived family and friend social support moderated the relationship between ACEs and alcohol-related problems but not ACEs and cannabis-related problems. The association between ACEs and alcohol-related problems was strongest at low levels of perceived family and friend social support. Perceived social support was not associated with cannabis-related problems. Conclusions: Lack of social support is a potential risk factor for alcohol-related problems among emerging adults. Bolstering perceived social support from family and friends among those who have experienced ACEs may be beneficial in intervention and treatment efforts aiming to reduce harmful substance use in this population.